Supporting the Anxious Mind with Children and Adolescents | Caroline Buzanko, Ph.D., R. Psych by jackhirose

2 DAY SKILLS PRACTICE INTENSIVE: SUPPORTING THE ANXIOUS MIND WITH CHILDREN AND ADOLESCENTS

MONDAY, MAY 8, 2023 – TUESDAY, MAY 9, 2023 | SASKATOON, SK

AGENDA

Understanding the neurobiology of anxiety and its contributors

• Gen Z, Generation Alpha, pressures, and technostress

• Normal vs. problematic worry

• Transdiagnostic approach to anxiety

• The nature of anxiety

• Anxiety & the brain

• Anxiety schemas

• 4 key routes to anxiety

• How anxiety shows up

• What maintains anxiety and the anxiety traps to avoid

• Student IPPs addressing anxiety

• Anxiety & neurobiology of trauma

Relationships and effective communication in addressing anxiety and trauma

• Rapport building and safety

• Effective emotion coaching

• Parent management and effective co-regulation

• Building emotional literacy

• Responding to anxiety in helpful ways

• Promoting confidence and independence

LEARNING OBJECTIVES

Establishing parent and child/teen buy-in

• Helping children and teens become experts of anxiety & their own neuropsychology

• Identifying and connecting the “Big Why”

• Collaborative agenda setting

• Motivational interviewing & values clarification

• Promoting an anxiety busting attitude

• Parent buy-in

• Addressing pushback

Externalizing and exposing anxiety

• Externalize and expose anxiety

• The trickster brain

• Identifying & individualizing henchmen

• Building awareness

Accepting anxiety & getting unstuck

• The power of paradox

• Acceptance vs. elimination

• Downfall of experiential avoidance

• Building emotion tolerance (and uncertainty tolerance)

• Explain the unique stress our children and teens face

• Differentiate normal and problematic worries

• Identify how anxiety manifestsin neurobiology, emotions, and behaviours

• Explain the key pathways to anxiety

• Identify the key variables that maintains anxiety and stalls progress

• Develop and provide client-friendly psychoeducation about anxiety

• Explain the impact of traumatic stress on the brain and how traumatic memory is stored

• Exercises to promote acceptance of somatic symptoms

• Building flexibility

Detaching from anxiety & enhancing the thinking brain

• Detaching from anxiety

• Interrupting rumination and overwhelm

• Strategies to demote anxiety

• Building the problem-solving brain (vs. strengthening the anxious one)

• Becoming rulers over anxiety

• Somatic integration

Daring and defying anxiety

• Functional assessments to individualize treatment

• Identifying fear cues and consequences, safety behaviours and functions

• Importance of stress inoculation

• Setting up exposures successfully

• Interoceptive exposure

• Interpersonal exposure

• Cognitive exposure

• Trauma approaches

• Habituation (and its traps)

• Maximizing fear extinction and safety learning

• Promoting an anxiety busting attitude

• Rewiring the anxious brain

• Creating an anxiety-busting lifestyle

• The risk-takers advantage

• Overcoming fear obstacles

• Addressing reverse hypnosis

• Effective responses to anxiety meltdowns and panic attacks

• Case examples

• Panic

• Social anxiety

• Generalized anxiety

• School refusal

Thriving from anxiety into the future and beyond

• Sustaining success

• Success bridges

• Breathing

• Mindfulness

• Healthy anxiety busting habits

• Changing baseline arousal levels & regulating the nervous system

• Discuss the shortcomings of traditional approaches

• Implement rapport-building tips and tools to improve relationships and create safety

• Engage as an effective anxiety coach

• Demonstrate skills to elicit buy-in from any child, teen, or parent

• Utilize strategies that help family members become effective emotion coaches for their children and teens

• Detect and challenge any of anxiety’s henchmen

Caroline Buzanko, Ph.D., R. Psych. is a licensed psychologist and clinical director of Koru Family Psychology. She has worked with children with neurodevelopmental disorders and their families for over 20 years, with a focus on maximizing connection, confidence, learning success, and resilience. In her clinical work, she specializes in the assessment and treatment of ADHD, ASD, learning difficulties, anxiety, and behavioural disorders. Through her specialized assessments, she helps parents and teachers understand kids’ strengths, areas of challenge, what makes learning easy, and how to best support them. She also offers therapeutic interventions to support children, teens, and their families.

208-197 Forester St, North Vancouver, BC V7H 0A6 t 604 924 0296 | tf 1 800 456 5424 | f 604 924 0239

Child & Youth Focused | 12 CEUs

WE ARE PLEASED TO WELCOME YOU TO A JACK HIROSE & ASSOCIATES WORKSHOP.

If you have any questions or concerns throughout the day, please notify your on-site coordinator.

PLEASE REMEMBER TO:

ü Wear your name badge every day

ü Turn off your cell phone

ü Hand in your evaluation forms at the end of each day

SCHEDULE:

This schedule may vary depending on the flow of the presentation and participant questions

8:00am – 8:30am Sign-In – Refreshments Provided

8:30am – 10:30am Workshop Begins

10:30am – 10:45am Mid-Morning Break – Refreshments Provided 10:45am – 12:00pm Workshop in Session

12:00pm – 1:00pm Lunch Break - Not Provided

Sign-In - CPA Members Only

1:00pm – 2:30pm Workshop in Session

2:30pm – 2:45pm Mid-Afternoon Break – Refreshments Provided

2:45pm – 4:00pm Workshop in Session

4:00pm Hand-In Evaluation Forms

Sign-Out – CPA Members Only

CERTIFICATES:

• Certifcates are available for all particpants to download.

• To download a copy of your receipt or certificate, please visit: http://registration.jackhirose.com/certificates

• Certificates will be made available to download once the workshop has ended.

Are you a member of the Canadian Psychological Association (CPA), Canadian Counselling and Psychotherapy Association (CCPA) or the Vocational Rehabilitation Association of Canada (VRA)?

Please read the important CEU information below.

• Please request a form from the on-site coordinator. Forms need to be filled out and submitted directly to the association by the participant.

• For CPA Members Only:

- New Policy as mandated by the Canadian Psychological Association

- CPA Members must take their name badge in the morning, sign in after lunch and sign out at the end of the day.

- Early departure means CPA Members are no longer eligible to receive CPA credits

- Certificates will be updated with CPA credits when the forms are returned to our head office for verification (please allow 2 – 4 weeks). Updated certificates are available for download here: http://registration.jackhirose.com/certificates

208-197 Forester St, North Vancouver, BC, Canada V7H 0A6 t 604 924 0296 | tf 1 800 456 5424 | f 604 924 0239

drcarolinebuzanko.com1 Dr.CarolineBuzanko,R.Psychologist www.drcarolinebuzanko.com info@korupsychology.ca SupportingtheAnxiousMind withChildrenandAdolescents Anxietyisthe mostcommon mentalhealth problemin kidsK-12… &theleadingreasonfor children’semergencyroom visitsandhospitalizations 2 Notsomething theyoutgrow 3 1 2 3

Untreatedanxietyistheleadingpredictorof depressioninteens&youngadults

drcarolinebuzanko.com2 …itusuallygetsprogressivelymoresevere. 4

Teensareextremely

susceptiblefordeveloping anxiety

4 5 6

Stress

drcarolinebuzanko.com3

especially vulnerable 7

Teensare

•Teensreportmorestressthan adultsjugglingallthedemands imposedonthem Moreexpectations •Morehomework Moredeadlines •Lessresources •Fewerbreaks/recess •Appearances 88

but Vulnerabletolearnthewrongthings 7 8 9

Primedtolearn

Alreadyincreasedstressresponses =increasedvulnerabilitytostress.

Addanymore:

•Effectslearningandmemory

•Greaterriskforothermentalhealthproblems

•Greaterriskofemotionaltrauma

•Increasedstress-inducedillnesses

•Altersthematurationofbrains

•

drcarolinebuzanko.com4 10 = Moodchanges& pooremotional& impulsecontrol =

Comparedtoadults,unabletocope

Effectscanbelong-lastingandevenirreversible 11

10 11 12

70%ofallmentalhealth problemsbegininchildhood andadolescence

80%ofchildrenand teensaffected negativelyfromCOVID

Earlyinterventionhelpsminimizelater problemswithdepression

Anxiety ImpairsDailyFunctioning

•Sleep!!!

•Academics

•Socialinteractions

•Happinessandoutlook

•Familyrelationships

•Doingthings/goingplaces

•Nutrition

•Self-care

•Independence

drcarolinebuzanko.com5

15 13 14 15

Intheclassroom, anxietyisan exceptionality thataffectshow studentslearn.

AnxietyLimitsLearning

Worrytakesupalotofcognitivespace…

•Poorattentionandconcentration

•Unabletofollowinstructions

•Unabletotransitionbetweentask

…therefore,superficiallearningishappening…

•Forgetthingspreviouslylearned

•Cannotremembernewconcepts

•Cannotgeneralizeknowledge

•Swisscheeseknowledge

LimitsLearning

drcarolinebuzanko.com6

16 17 18

LimitsLearning

LimitsExecutive Functioning

AnxietyImpairs SocialSuccess

drcarolinebuzanko.com7

•Slow,limitedproductivity •Mayperformaswellasothersbutalot moreefforttodoso •Perfectionism •Missedassignments •Procrastination •Workslowly •Delaytransitions •Ritualswithchecking •Rereading •Organizingmaterials •Rewriting 19

•Attention •Impulsivity •Organization •Planning&Prioritizing •Initiation •Workingmemory •Decisionmaking •Self-monitoring **Inconsistentperformance 20

ThisPhotobyUnknownAuthorislicensedunderCCBY-SA 19 20 21

drcarolinebuzanko.com8 Mostgowithouteffectivesupport 22 Why? •Ofchild •Ofanxiety (Mis)Understanding Parentsthinktheycanhelpontheirown Cost Generalpractitioners Waittosee 23 Veryfewseekhelp •Adultsjustdon’tunderstand •Therefore,youcannothelpme •Fear •Beingmisunderstood •Nottakenseriously •Forcefullytakenoffline •Beingdiagnosedorstigmatized •Leftwithoutanycontrol 22 23 24

drcarolinebuzanko.com9 Understand 26 Physically Cognitively Behaviourally FightFlight Response Worriesare heretostay •Normal,protectivefeeling •Necessaryforsurvival •Itsok! •Temporaryinthemoment

Notdangerous

Nottobeeliminatedoravoided

Canhelpmotivate&energizeus 27 25 26 27

•

However,whilesocietyhaschanged somucheveninthepasttwo decades,ourbrainhasnotchangedin hundredsofthousandsofyears…

Worriestobeexpected

Developmentallyappropriatefears

•Survival:separation,danger

Lifetransitions

•Newschool,graduation,changeinfamilycomposition,teenageyears

Stressfulexperiences

•Neworunfamiliarsituations

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builttoprotect us…

Thebrainwas

thatmakesthatbrainmeantto protectustoactuallyharmus 29

Societyisnowcreatedinaway

28 29 30

drcarolinebuzanko.com11 Adolescence •Social •Whatothers think •Family gettingsick •School performance •World events •Afterhigh school!!!! PreAdolescence •Homealone •Familyor pets •Rejection •Mortality, health Elementary •Changes •Performance •Gettingsick orhurt •Animals, monsters, ghosts •Natural disasters Early Childhood •Fearofdeath orghosts •Separation •Dark •Gettinglost •Thunder Preschool •Animals, dark, thunder,fire •Nightmares •Monsters& shadows •Novelty Infant/ Toddlers •Separation •Novelty •Loudnoises •Shyness,fear ofstrangers •Santa Worriestobeexpected Worriestobeexpected 32 TEMPORARYDONOTINTERFEREWITH FUNCTIONING STUDENTSSTILLSUCCESSFUL INACHIEVINGGOALS 33 BEGINNINGMIDDLEEND 31 32 33

Anxiety Disorder

Significantinterference(home,school, social);anxietystartstomakedecisions

Significantdistressthatismorefrequent andmoreextremethanthatofpeers

drcarolinebuzanko.com12

Anxietymakesthedemandsfeelwaybiggerthanwhatthey believetheycanmanage. 34 35 36

It’sallinhowwerespond Basedonhowweperceivethedemandsofthesituation.

34 35 36

drcarolinebuzanko.com13 37 Excessiveanxiety& distress •Stomachorhead aches •Lotsofreassurance seeking •Avoiding school/crying Mondaymornings •Lashingout •Sleepdisturbances Disruption •Poorschool performance •Sociallyisolated •Notmakingfriends •Avoidtryingnew things •Schoolrefusal •Nocarefreeand playfulchildhood! AmygdalaBasedMemories Emotionalmemories •Outofawareness •Rememberedvery differentlyfrom ourconscious memories 39 37 38 39

drcarolinebuzanko.com14 Cortex Based Stress Ruminate&try tosolvethe problem Visualimages &imaginative worries Thebraincannottellthe differencebetweenwhatit actuallyseesandwhatitimagines 42 40 41 42

drcarolinebuzanko.com15 43 Expectingsomethingbadtohappen Kidscontinuetoworrythemselves withtheirownthoughts Schemas Emotionsvs.Feelings Differentaspectsofinternalexperiences 45 43 44 45

HowAnxietyManifests: Affect

•Frequentdoctorvisits

•Releasedhormones

•Increaseheartrate

•Increasebloodpressure

•Increaseenergy

•Increasealertness

•Slowsotherprocesses(tofightor runaway)

•Secretesacidintothestomachto emptyit

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•Emotion •Physicalsymptoms •Sensitivitytosymptoms

•Poorschoolattendance

Physical Symptoms areaProblem 46 47 48

Theystarttoworryabout thephysicalfeelings,which aredistressing,andjust wantthemtostop!

Wegetreactive! Misinterpretasdangerousandleadsto morefear,moresensations…

•

HowAnxietyManifests: Thoughts

•

drcarolinebuzanko.com17

50 Thisis normal!!! AndNOT dangerous!

Unrealistic,extreme

Whatif’s…

Everyoneisgoingtolaugh

Theworldisdangerous

Catastrophicthinking 51 49 50 51

HowAnxietyManifests: Thoughts

Brainbuiltforsurvival–itsjobis NOTtobehappy

•Negativitybias(primedtosee non-existentdanger)

•Uncertaintymisinterpreted

•Seeeventsasthreats

•Becomesingrained

HowAnxietyManifests: Behaviours

ThoughtsLeadtoPatternsof Behaviours

Basedonthebeliefofhowtheycan manage

Ican’thandleit!

•Believetheyareincompetent

•Dependencybehaviours

•Seekingreassurance

•Seekingassistance

•Repetitivequestions

•Prepareunnecessarily

•

drcarolinebuzanko.com18

Clingy

Co-sleeping,callhome 54 52 53 54

•Easilytriggered

•Disrespectful Oppositionalanddefiant

•Difficultytransitioning

Aggression/intimidation

•Difficultiesconcentrating

•Liesorsteals Temperoutbursts

•Restless/fidgety Interrupts/Intrudes

•Impulsive

•Giveupeasily

•Argumentative

•Yell

•Repetitivequestions

•Seekconstantapproval

Behaviours:Internalizing

•Withdrawn/isolated

•Shy

•Sad/irritable

•Head/stomach-aches

•Eatingissues(under-orover-eating;food intolerances)

•Sleepproblems/Fatigue

•Lowself-esteemandconfidence

•Rejection

•Repetitivebehaviours/obsession

•Difficultiesconcentrating,fidgety

•Avoidance

•Disorganized

•Cry

Exposedtosomesituationthat threateneddeath,seriousinjury,or sexualviolence

•Directlyexperienced

•Sawithappeningtosomeoneelse

•Heardaboutithappeningtosomeonethey love

Howpeoplerespondisimportant

•Noteveryonetraumatized

•Mostpeoplerecoverwithoutlong-term impairments

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Behaviours: Externalizing

Substanceuse Trauma

55 56 57

Traumavs. Anxiety

Everyoneisunique!But:

•Hastherebeenatraumatic event?

•Lifethreatening?

•Feltlifethreatening?

•Neglect

•Chronicemotional/verbal abuse

Traumavs.Anxiety

Trauma

Reactionofsomethinginthepast

Recurringruminationofpastevents

•Potentiallossofawarenessofthenow

•Groundhogday

Samephysiologicaltraumareaction triggered

Changeinworldview

•Lossoftrust

•Lossofloveforlife

•Viewselfmorenegatively

Anxiety

Anticipatingsomethingbadhappening inthefuture

Ruminationofwhat’stocome

•Thoughtscomeoneafteranother

Physiologicalsymptomsmayappear

•Notthesameasthetraumaticreaction

Trauma&Anxiety

•Anxiouspeopleatgreaterriskfor traumaticreactions

•Anxietycantriggeratraumaticevent

•Publicpanicattackandfeelinglike you’regoingtodiewitheveryone watchingyou

•Scaredaboutfuturepanicattackscan triggerpanicdisorder

•Anxietyandtraumacanreinforceeach

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other 60 58 59 60

Fight-flightanautomaticprocessdeep inthebrainstem

•Brainstemhasadirectconnectiontothe backofoureye

•Reacttothingsoutofourawareness

•Alwaysactivated–quickresponse!

•Everythingfeelsthreatening

•Hyperalertforeverything

•Can’ttellwhat’simportant

•Can’ttellwhatishappeningnow vs.inthepast

•Overwhelmed–thebrainandmind can’tprocesswhat’sgoingon

Freeze&Shutdown

•Parasympatheticsystemactivates

•Musclesfreeze

•Gazemayfreeze

•Breathmayfreeze

•Mayshutdowncompletely(enterano painstate)

•Unawareofwhat'shappeninginternallyor externally

•Can’tprocess

•Rumination Shame

•Self-blame

•Disconnectbetweenthepastandpresent

Trauma

•Adrenalineputsamygdalainto hyperdrive

•Laysdownbigemotional memories

•Cortisolshutsdownour hippocampus

•Memoriesarenotproperly integratedandbecome traumaticmemories

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63 61 62 63

TraumaAffectsDifferentTypesofMemories

drcarolinebuzanko.com22 Nervoussystem Emotional brain Thinking brain Trauma Sensorysystemoverwhelmed &cannotintegrateallthe information

SemanticMemory •Knowledge&facts EpisodicMemory •Memoryofanevent, who,what,where •Canbetriggeredby senses EmotionalMemory •Memoryofemotions feltinthesituation •Emotionspopupout oftheblue Procedural Memory •Howtoperforma tasksubconsciously 65 ExplicitMemoryImplicitMemory

SemanticMemory •Preventinformationto combine EpisodicMemory •Shutdown&fragment sequence EmotionalMemory •Triggeredwithout context ProceduralMemory •Tenseormove differently unconsciously 66 ExplicitMemoryImplicitMemory 64 65 66

Flashbacks keepusstuck

Sustainstheoriginal traumaticmemory

Trauma&Context

Thenervoussystem andbodycan’ttellthe difference–feelsthe sameastheoriginal trauma

Unintegrated traumaticmemories triggerthesurvival response

BrainShortcuts: Importanceof Context

•Turkeymothers

•Goodmothers

•Allmotheringis triggeredby“cheepcheep”

•Smell,touch, appearanceminor roles

Reminds meof…•Integratedcontext

Flashback

•Unintegratedcontext

•Samesensations& emotionsasoriginal trauma

•Bodycan’ttellthe difference

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67 68 69

drcarolinebuzanko.com24 How trauma showsup Intrusive thoughts Nightmare,or flashbacks Hyperarousal Unpredictable moodswings Negative outlooks InattentivenessHopelessness Impulsiveness Sleepproblems Avoidance& withdrawal Behavioural outbursts 70 Everyoneispredisposedto anxiety. OurKidsare Stressed 72 70 71 72

CompoundingInternal&ExternalStressors

•Shoulds School

•Teachers •Coursedemands&performance

•Demandsandexpectations

•Familystressors Parents

Peerpressures

•Ownstress&fighting

•Tryingtofitin

•Substanceuse

•Relationships

•Notimeforplay,creativity,orrelaxation

Lack•Notimetolearntocope ofdowntime

Development

Uniquepersonal stressors

•Navigatingstrongemotions

•Buildingidentity

•Makinglifedecisions

•Health

•SensorySensitivities

ChildrenandTeens’MentalHealth

DisruptedroutinesLackofaccessto resources Lackofsocial support LackofstructureInconsistent schedules

Poorlydefined rulesand expectations

Limitedlearning opportunities(and opportunitiesto makemistakes!) Lackofstimulation Inabilitytoexpress themselves effectively

FamilyconflictLackofmeaningfulsocialinteractionsFewerrewards

Lackof understanding& magicalthinking

Farmore:

•Depression

•Self-harm

•Suicide

drcarolinebuzanko.com25

Current Stateof theworld Social disconnection andloneliness Identityand bodyIssues Multiple pressuresand high expectations

Socialmedia Localandworld news

WorthlessnessHelplessness

73 74 75

Noexceptions:

•

Pressureand expectations

drcarolinebuzanko.com26 Screen time Loneliness Depression Withdrawal Anxiety SuicidalSuicidalideation planning Disorderedeating Self-esteem PoorSchool performance

ALLscreentimeislinkedtolesshappiness.

Morescreentime=

Schoolstruggles

•

Loneliness

Depression

Suicidalthinking

76 77 78

drcarolinebuzanko.com27 Self-esteem Falsemessagestoavoid rejection •Sohappy! •Sobeautiful! “Likes”worsensself-esteem •Otherswon’tlikethe “real”them. Perfection Schoolachievement Appearance Happiness Perfection Masculinitynorms Expectationstosucceed Limitedopportunitiesto expressemotions Limitedmeaningfulmale friendships 79 80 81

drcarolinebuzanko.com28 EffortlesslyPerfect Overachieve academically Highexpectations inallareasoflife Expectationsto behappy Effortlessly Perfect 1--------------------------------------------------------------------------10 MythofHappiness 82 83 84

Technostress

•Hardtodetach=chronicstress

•Don’treceiveanimmediatereplytoatext=anxietyandisolation

•Technology-relatedanxiety(e.g.,pressuretorespond immediately)

•Shame&stigmaifnotconnected

•Validationthroughsocialmedia

drcarolinebuzanko.com29

85 Associal media time Increases Perceived exclusion andsocial Isolation also increases FOMO SocialDevelopment& SocialHealth Fomo Makeseverythingelseless Important Becomesopreoccupiedwithwhatis happeningonlinevs.inthemomentAtthecostofrealinteractions Feelingevenmore isolated 85 86 87

Massive-Scale Emotional contagion

Webegintoexperiencethe sameemotionsasothers withoutourawareness

•Long-lastingmoods(e.g., depression)canbe transferredthroughsocial networks

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Mostimportantrelationshipfor bondingandoveralldevelopment Discovering: Self Values •Personality •World FamilyConnection Nolonger turningto parentsto debriefdayand hurts Screensarereplacing parentsanddisrupting familydevelopment 88 89 90

Breakingthecyclethatfuelsanxiety

drcarolinebuzanko.com31 DigitalImmigrants vs.DigitalNatives Noissuebigenoughtoriskbeing disconnected 91 Bullyingdoesn’t happenprivately anymore Sendingunsolicitedand/orthreateninge-mail. Encouragingotherstosende-mailortooverwhelm thevictim Posting/spreadingrumours. Makingdefamatorycommentsonline Sendingnegativemessages Sexualremarks Postingthevictim’spersonalinformation Hatespeech Impersonatingthevictimonline Harassingthevictim Leavingabusivemessagesonline,includingsocial mediasites Sendingthevictimpornographyorothergraphic materialthatisknowinglyoffensive Creatingonlinecontentthatdepictsthevictimin negativeways Trolling Cyberstalking Hateraids 92

91 92 93

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intheworld

*Impairshealthyindependence *Inhibitsresilience *Disruptstheiremotionregulation *Worsensanxiety *Contributestoemotionalexhaustion *Canleadtoaggressivebehaviour *Increasesriskofsubstanceabuse andriskybehaviors AND,goesagainsthowthebrainandbodywork,weneedtolearntounderstand thesesignals! 96 94 95 96

AdultTraps Thisalonecanmakeallthedifference

There’snocryinginbaseball!

drcarolinebuzanko.com33 Kidslearnanxious behavioursfrom adultsintheirlives 97 Saying “Don’t worry” doesn’t work 98 Getstuckinconstant needforreassurance Noskillsdeveloped Minimizing Braininhighstress state=amygdalakicks inandbecomesastop signforInformation andanyrational thinking 99 97 98 99

drcarolinebuzanko.com34 Anxiety… •Wantscertainty •Wantspredictability •Wantscomfort Problem#984with technology: Ittakesuncertaintyaway 101 102 Whereareyougoing?Whattime? What’stheweatherlike?Takeyourjacket,justincase. Remembertolookbothwayswhenyoucrossthestreet. Gostraightthere. Don’ttalktoanyone. Rememberyourmanners!Saypleaseandthankyou. Benice.Getalong.Followhisideas,ok. Remember,you’retheguest,solethimbetheleader. Whoelsewillbethere?

Canyouaskhismomtocallmewhenyougetthere? 100 101 102

Beagoodfriend.Includeeveryone. Hismomwillbethere?Whatabouthisdad? Makesureyoukeepyourmouthclosedwhenyouchew. KeepyourelbowsoffthetableIfyouhaveasnack. Don’thaveanysuckersthough,ok. MakesureyoucallmewhenyouleavesoIknow. Makesureyoulookwhenyoucrossthestreetcominghome.

drcarolinebuzanko.com35 Mayaswellfigureouthowtonavigatethem 103 104 Protect Deflectfailure Smoothpathahead 105 Entitlement •Everythingcomeseasily •Everythingalwaysworksout •Expecteveryrewardthereis Poorcoping •Noopportunitiestomanage stress •Avoid •Anxiety 103 104 105

drcarolinebuzanko.com36 AccommodationBehaviours Participation •Assistinchecking behaviours •Assistinavoidance •Reassure Modification •Preventanxiety provoking situations 106 Accommodations worsensanxiety long-term 107 Anxietymoreimpairingandsevere withpoorertreatmentoutcomes Whatareyoudoingforthechildorteen thatyouwouldn’tbedoingifnotfor anxiety? 106 107 108

drcarolinebuzanko.com37 Speakingforthe student Allowingstudents tobeexcused Ensuring predictabilityAvoidingoutings Sittingoutof anxietyprovoking situations(e.g., gym) Onlyhavingone substitute Participatingin rituals Notthrowingaway unnecessaryitems NotopeningwindowsRigidroutines Seeingschool nurseunnecessarilyLeavinglightsonChecking homework Accompanyingthe childtocertain partsoftheschool Distraction AdjustingroutinesAlternateplaceforlunchFixedschedulesPre-warningsandTransitionwarningsStressballs Accommodationsarereactive.Theytakeawaykids’ abilitytoself-sootheandproblemsolve. 110 Avoidanxietysituations Adjustingroutines Allowthemtobeexcused;slow-re-entry Distractthemorstopthoughts Alternativeplaceforlunch Fixedschedulesandtransitionwarning Stressballs Minimizeanxiousfeelings Considerstudents’IPP’s 111 Doesitaccommodateanxiety? Areskillsbeingtaught? Isthereatransitionplan? Doestheplanaddressphysicalsymptoms? 109 110 111

•Nopick-upplan

•Alternativestophonecallshome

•Nameofworry

•Sameresponses

•Parentcoaching(e.g.,howtorespondtotexts/calls)

•Stipulationsabouthome-schoolcommunication

drcarolinebuzanko.com38 Considerstudents’IPP’s 112 Doesitusespecificlanguage?

Doesitdocumenthowtomaintaincontact betweenhomeandschool?

Ensureskills-basedgoals(vs.avoidancebased)

Doesitpreventanxietyshowingup? Howdobreaks/officevisitshelp?

•Ifleaves,plansforquickreturn

SkillsINtheclass

Consistentlanguage withhome

•Weaningoffplans Detailedand specific 113 AccommodationsBecomeSafetyBehaviours! (Usedtoattempttominimizeorpreventsomethingbadfromhappening) Avoidance Excessivechecking Seekingreassurance Rituals Safetyaids 114 112 113 114

•Everyone’sroleandresponse •Minimalreactions–anxietyissoannoying

drcarolinebuzanko.com39 115 Watchout for dependency traps Avoidtraps •Adultsjumpinginharmskids: •Changesbraindevelopment&ingrainsanxiety •Makeskidsvulnerable:Confidenceandresiliencestunted Noopportunitiestoexperiencemanageableamountsofstress •Noopportunitiestoseethatwhattheyfearisnotdangerous 115 116 117

drcarolinebuzanko.com40 The#1 thingthey needto learn? 119 Howtheymanagethe experienceofanxietyis relatedtoanxietydisorder Nottheactualtrigger 120 118 119 120

drcarolinebuzanko.com41 Connect Adult perceptions Worries&Stressarecontagious 121 122 123

Optimal

drcarolinebuzanko.com42

functioning through co-regulation BeagoodRoleModel: Nooneisimmune Displayvulnerability&copeoutloud •Empowering •Promotesbravery,confidence,& resilience BeagoodRole Model •Beingscared&doingit anyway •Modeleffectivecoping •Seekandreceivehelp •Recognizeownunhelpful thoughtsandbehaviours 124 125 126

ODDvs.Anxiety?

drcarolinebuzanko.com43 Self-fulfillingprophecy Expectations 127

” 128

“Themomentyoudoubtwhetheryoucan fly,youceaseforevertobeabletodoit.

~J.M.Barrie,PeterPan

127 128 129

drcarolinebuzanko.com44 Nosuch thingas badkids. EmotionsLeadtoBehaviouralresponses Assert, Angerdefend ShameAvoid Flee, Fearfreeze Support, Sadnesswithdrawal Connect, Joyengage Attend, explore Excitement FunctionofEmotions 132 Disappointment Hurt Fear 130 131 132

drcarolinebuzanko.com45 FunctionofEmotions 133 Anger Disappointed Sad Hurt WorriedEmbarrassed Guilty Lonely Manyhave worriesabout abandonment. Rejection WorthinessAbandonment Unlovable FailureNotbeingvalued 133 134 135

Core emotional pain

Shame-based experiences

Lonelinessbased experiences SADNESS

BehaviouralStoriesNeeds patterns Responses (internal/external situations)

Rejection,judgement, humiliation,negative self-treatment

Hide, disappear, shrinkaway, actout

Grieveoract out Isolation,lossof connection/lovedone

Fear-basedFear,lackofcontrol experiences

Iamflawed, worthless, don’tdeserve goodthings

Iamonmy own,lonely

EscapeNotsafe oract out

Considerproblem behavioursrelatedto

trauma

•Predictableoutcome:safetyfor thenervoussystem

•Gettingcloseisuncomfortable–easiertodisrupttherelationship (becausetheyarescaryand painful)

•Distractsfromuncomfortable feelings

•

Behaviour!

Freeze,distracted, non-compliant, explosive

Anxiety, self-doubt &criticism

Tobevalued,appreciated, recognized,accepted, validated

Closeness,support,love, connection,caredfor, inclusion

Safety,stability,protection, control,personalstrength

Assigned task Challenged (perceived orreal)

138

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Lessvulnerable 137

Reprimanded

136 137 138

andstrengthens worries

drcarolinebuzanko.com47 Consider feedbackloops Fail&Avoid Fail&Avoid FailFail&Avoid &Avoid Fail&Avoid 140 FBA Skilldeficit Teachskills SocialComm.Emotion regulation Rewarding Attention, task avoidance, stimulation Skilldeficit! Teachhowto getneedsmet Nobadkids!!!Whataretheydefending? Iftheyaren’t experiencingsuccess withmanaging anxietyand managing challenges,they becomeevenmore vulnerable Success Success SuccessSuccess Success 139 140 141

Relationship

Protectorfrom:

Violentbehaviour

Schoolfailure

Schooldropout

Substanceabuse

Depression

Suicidalideation

Unwantedpregnancy

Long-termhappiness

•Findawayin

•Createstrengths-based opportunities

•Acknowledgeadaptive behaviours

•Collaborate

•Nonjudgmentalstance

•Showstatusandrespect

•Validate

•Avoidpowerstruggles

•Teach!

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144 142 143 144

drcarolinebuzanko.com49 Relationship:Howdoyoushowup? Onesmallchangeinyourinteractionscanbeagamechanger. Droppingout Student alienation • Relationship with teacher Values Discovery Activity Identifyteachingorparentingvalues Goalsforteachingorparenting Hopesforstudents’orchild’sfutures Professional/PersonalMissionStatement 145 146 147

drcarolinebuzanko.com50 Youhavelessthan 6minutes 148 •Kidsneedtofeellikedand respected •WhatcanyouDOtostrengthen yourrelationshipeveryday? Multipleadultsathome,school,andcommunitypartoftheirfanclub Safe,nurturingrelationships… Bullied Mr.A Mrs. B Ms. D MathMs. W Writing Mr.A Mrs. D 148 149 150

Safe,nurturing relationships

•Senseofcontrol

•Senseofbelonging

•Lunchbuddies

•Anycueofsimilarity

•Colouredshirtsorwristbands, birthdays,classshirts,team jerseys

•Websofconnections,peer mentoring

Safe,nurturing relationships…

•Senseofcontribution

•Collaborativetests.

•Brainstormideasinsmallgroups howtosupportpeers/otherclasses

•Acknowledgepeerandteacher birthdays

•Evaluateprogramsandactivities

•Writtensurveysandfocusgroups

•Brainstormideasforimprovement

Reciprocityring

Easiertoaskforhelp–everyoneis!

Initiatehelpingothersontheirown

Promotesgenerosity

Promotescontribution

Createsconnection

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152

151 152 153

drcarolinebuzanko.com52 155 Emotion Coach 154 155 156

drcarolinebuzanko.com53 Usemirrorneurons Braincan’ttellthedifference 157 Showconfidence =FEEL confidence Emotioncoach Coachesdonotreassure–avoidtraps: •Answeringquestions •Reviewingtheschedule •Answeringeveryphonecallortext message •Checkingthings •Reassuring 157 158 159

Emotioncoach

Coachesvalidate&thenask open-endedquestions.

•Whatareyougoingtodo?

•Howareyougoingtofigure thatout?

EffectiveResponse

CoachingCues

•Showconfidencethattheycanfigureit out

•Collaborateideasre:howtheycan figureitout

•Helpthemmakepredictions

•Ipredict…(e.g.,Iwillfeel8/10proud whenIamdone.).

•Focusonlearning

•Howdidyoudo?

•Whatwentwell?

•Whatdidyoulearn?

•Whatwillyoudodifferentlynext time?

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160 161 162

Effective CoachingCues

Iknowyoucanfigureitout.Brainstormwith _______andmakeaplan.Lemmeknow!

Ilookforwardtohearingthepositivethingsyou willsaytoyourselfasthisgetshard.

Letsbrainstormthewaysyoucanbossbackthis innercritic.

Whatareotherwaystodealwiththisproblem insteadoffighting?

Iknowyoucanstickupforyourself.Whatare thingsyoucansaytothem?

ThepowerofIDon’tKnow

164

Whenthingsgo sideways

Todayisyourluckyday!

•Thismeansyougettotry again!Yay!

•Nowwehaveallofthis informationwecanlearn from…Nowweknowso muchmore

•Whatdidyounotice?

•Whatdidyoulearn?

•Whatneedstohappen nexttime?

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163 164 165

drcarolinebuzanko.com56 EffectiveCommunication 166 Wecannot instill motivation FixPush DisciplineDirect CommunicationStyles Director •Adultas expert Guide Follower •Studentas leader 166 167 168

Director

Focusonlack anddeficits

Pullupyour socks

Consequence

•Tooinvolved

•Cripplesresilience andmotivation

•Undermines learningand autonomy

Follower

•Noattention atall

•Passive

•Focusonstrengths

•Askopen-ended

•R+competence& confidence

•Promotesautonomy

•Promotesmotivation &engagement

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questions Guide 169 170 171

EffectiveCommunication

•Youacknowledgetheir feelings

•Youacknowledgetheir perspective

•Yourattitudeis respectfulandcaring

•Yourespecttheir autonomy

Notsogreat Communication

•Youignoretheirfeelings

•Youignoretheir perspective

•Yourattitudeisnot respectfulandcaring

•Youtrytolecture,teach, orfixthesituation

Connect

•Compassion

•Acceptance

•Collaborative

•Evocation

Withthatattitudeit’snowonderyouare failing.Icalledyouinheretotellyouto straightenupifyouwanttohaveanyhopeof passingthisclass.

Icanseethatyoutriedhard,anditisn’teasy.I wantedtocheckinandseewhatIcoulddo thatwouldbehelpful?

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Talkingwillonlyescalatetheproblem 174 172 173 174

drcarolinebuzanko.com59 Givespaceforregulation StepsofanEffectiveEmotionCoach Awareness •Oftheiremotions •Ofyourown emotions Recognize opportunity Listen •Empathy •Validate •Fullypresent •Patient Teach •Labelemotion •Expressemotion withwords Problemsolve 176 Effective Communication Tips Talklesslistenmore 175 176 177

drcarolinebuzanko.com60 Effective Emotion Coaches Focusonconnection&safety •Empathy&Physicalsafety •Validate&acknowledge •Howtheyarefeeling •Howtheyperceivethesituation

Bepresentwiththesituationyourself

Beingpresentisbetterthanwords Beprepared! LetmeseeifIgotthat.Yousaid… DidIgetit? Istheremore? Thatmakessense… Effective Communication Tips •Keepthewaterscalm!

Reducenagging&prompt dependency •Notpersonal •Thankyou! •Focusongoal 178 179 180

•

LabellingEmotions

drcarolinebuzanko.com61 Howwetalkis important Replace negativitywith curiosity Andcontrolanddemandingnesswithwarmth andresponsiveness

•Nameittotameit •Buildsconfidence •Helpscalm 183 181 182 183

LabellingEmotions

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•Model •Buildemotionvocabulary •Foresight 184 185 Dizzy Racing Tension Achy Sore Hot Cold Tingly Relaxed Trembling Numb Sharp Nausea Breathless Shivering Sweating Troubleswallowing Tired Emotioncoaches 186 Clearexpectationsabouthowadultsaretorespond(withsupport&confidence vs.reassurance) Consistentacrosscontexts Consistentacrosspeople Motivation 184 185 186

drcarolinebuzanko.com63 Warning! YouWILLgetpushbackwhenadultsstarttochange theirresponse!!! 188 Wehaveour ownunique interpretations 189 187 188 189

drcarolinebuzanko.com64 190 Traumaconsiderations Kindnessandcaringattentioncanbeproblematic Trauma considerations: Collaborate! Alwaysremembereveryone hasdifferentexperiences. Createaguideandget themtolead 190 191 192

Whatdoyouneed fromotherswhen dysregulated?

Weallneeddifferentthings whenwe’redistressed

Needto manageour ownstress, perceptions &responses sowecan provide:

Choice

Context

Connection

Choice

•Nocontrol=fight/flight

•Buildsconnection

•Choicestimulatesinnersecurity(innerwisdom)

•Empowering(wetrusttheirownexpertiseandinternalresources)

•Smallchoicesininteractions

•Choicethroughelicitingtheirinnerwisdom

•Getmeta!

•Getmindful(noticingnow)&followthat

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193 194 195

•Context

•Nervoussystemonalert

•Arewesafe?

•Isitsafetoengage?

•DoIneedtorunaway?Orshutdown?

•Connection

•Fundamentalpriority

•Physiologicallyconstantlyseekingconnection

OptimizingSelfRegulationThrough Relationship

Down-regulating “negative”emotions

•Being

•Tolerating

•Validating

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196 197 198

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Up-regulating“positive”emotions •Expandpositiveemotionalvocabulary •Focusonstrengths&positivecoping •Exceptions •What’sworking •Visualization Inspire Otherwise,you getresistance 201 199 200 201

OptimizingSelf-RegulationThroughRelationship

drcarolinebuzanko.com68 202 WhatisImportant 203 Socialgoals Makegoodchoices Tolearneffectively Havefun Externalrewards 204 202 203 204

CostBenefitAnalysis

Benefitofbeingslavetoanxiety

Peopletellmewhenthingsaregoingtochange soIamalwayscomfortableandneverstartled IcantakeabreakwheneverIwant

Easier

Morecomfortable

Won’tmakeamistake

Costofbeingslavetoanxiety

NothingisalwayspredictableandIgettooupset whensomethingunexpectedhappens Ioverreact/cry–kidsmakefunofme

Ican’tgotosleepovers

Momalwayshastocomeonfieldtrips

Can’tdoanythingonmyown

Feellikeababy

OtherkidsaregettingbetterandIamstillstuck

Allthethingsanxietymakes youavoid

•Seeingfriends

•Sleepovers

•Birthdayparties

•School

•Tryoutsforsports(and thereforesportteams)

•Sleepinginownbed

•Makingnewfriends

•ButImissoutongoingtoBF’shouse becauseshehasadogIavoiddogsbecauseImightgetbit

Iavoidputtingmyhandupinclass becauseitmightsounddumb

•ButImissoutonsayingthingsIwanttosay, especiallyreallygoodideas

•ButImissoutonhavingfunwithmyfriendsIavoidsleepoversbecauseIamworried Iwillhavetogotothebathroom

•ButIfeellikeabigbaby

Iavoidbeingalonebecausesomething mighthappen

•ButImissoutonlearningandseeingfriendsIavoidschoolbecauseImightthrowup

•ButImissoutonorderingwhatIreallywantIavoidorderingfoodbecauseImight messItup

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205 206 207

•Whytheywanttocontrol theirownlife

•Howexhaustinganxietyis

•Howlifewillbedifferent

•Whattheyaremissingouton

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210 Anxietyisnormal,temporary, &notdangerous. Iamnotalone. Anxietyknowshowto overwhelm. BUTanxietyistotally predictableandtreatable. Withexpertise&confidence,theyremember: 208 209 210

drcarolinebuzanko.com71 Understand Anxiety& Whatit does…. •Amygdala •Sizeandshapeofanalmond •Ouralarmsystem/watchdog •Canbehelpful Whenthealarmgoesoff,thebodygetsreadytofightorrun Evenwhenitisafalsealarm! Thebrainandbodycannottellthedifferenceandwill stillgetreadytofightorrun. 211 212 213

drcarolinebuzanko.com72 214 Transient Nature: Automatic& Unpredictable Anxietyisnotinthe situationbutthefeelings wehaveandhowwe perceivethosefeelings Understandingthisconnectionmakesiteasiertoresponddifferently Feelings BehavioursThoughts 214 215 216

EmotionsAreTellingUs SomethingAboutReality (ourthoughtsmakeup conspiracies)!

•Helpwithlearning

•Guide(andmotivate)our behaviours

•Canhelpusproblemsolveand respondflexibly

EmotionsAreTellingUsSomething (justlikePhysicalPain):

Understandthetruths!

Ourbodiesareintuitiveanddesignedtoprotectus.

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Eat pooh No Disgust Get eaten No Fear Gluttonfor punishment with unattainable goals No sadness Picked on No Anger Nofuture motivation No misery (e.g., after triumph)

Itdoesn’tmakesenseifitwasdoingsomethingtoharmus. Trustittodoit’sthingandgetoutofitsway. Wedon’tneedtoaddcommentary. 219 217 218 219

drcarolinebuzanko.com74 Understand thetruths! 220 Heartscanbeathardallday longandstayhealthy Ourbodywillalways compensateforbreathing We’dbeextinctifwealways faintedindanger. •FaintinghappenswithLOW bloodpressure. •Whenanxious,lotsofblood isflowing! Tensionbuildswhenweare notdoinganythingwiththe energy •Getmoving:Shake! Forcingourselvestoswallow won’thelpusswallow •HumorsingEmotionscomeand,more importantly,theygo Stress Hormones Creative Mind Worried thoughts 221

222 220 221 222

Whenuncomfortable, EVERYONE’sbrain wantsustoquit.

drcarolinebuzanko.com75 Eventhetoughest ofthetough 223 Howyoutalkaboutitisimportant 224 Blaminggeneticscreatesthe beliefthereisnothingIcando tochangemyanxiety 225 223 224 225

drcarolinebuzanko.com76 Blaminggeneticscreatesthe beliefthereisnothingIcando tochangemyanxiety Teach:geneticexpressionand chemicalmakeupare changeable. 226 Stress&Perception High Levelsof Stress Beliefthat Stressis Bad Premature Death Stress&Perception High Levelsof Stress Nobad beliefs about stress LOWEST riskof death 226 227 228

Emotionsaresimply emotions!

drcarolinebuzanko.com77 StresspromotesDHEA, whichpromotes.Athigh levels,itpromotes: •Braingrown •Immunesystem •Resilience 229 Stresscanbe enhancing!

Wecanexperiencedifferentemotionsdespitetheexactsame circumstances. 230 Threatvs.ChallengeResponse Notgoodorbad,differentpurposes Threatresponse–Situationswearen’tequippedto handle •Rushofcortisoltodefendandprotect •Justtryingtosurvive Challengeresponse–Hardbutmanageablesituations •Moretestosteroneandadrenalinetohelpusachieve ourgoal •Opportunityforgrowth 231 229 230 231

Keysto

Stress&Worries

drcarolinebuzanko.com78 Differenthormones releasedtopreparefor what'stocome. Howdoesourbody know? 232 Dependslargelyonour evaluationofthesituation.

Values Whatis important Resilience BraingrowthProductivityPrioritization Energy Relationships

success: Selfefficacy IbelieveIcan(cognitive) Ifeelgoodabouttrying(emotions) Ihaveaplanandgoingtodomybest(behaviour) 232 233 234

Expectpositive outcomes

Howdohighschoolstudentscopesocially whentheyaretoldthatpeoplecanchange sociallyrelevanttraits?

Expectpositive outcomes:Theywill too!

Theygotoveranxiety&improvedtheir stressresponsetosocialinteractions

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235

Wecanchangeourbrain!

235 236 237

WeCanChangeOurBrain!

•Ourbrainisbuiltforustobesuccessful

•Brainnetworksfixandgrowwhenwelearn newskills

•NeuralbundlesDOUBLEwithanhourof practice

•Rewireourbrainthroughrepetitionand practice

•Whateverisnotused,thebrainprunesitself

WeGrowOurBrain

WheneverWe:

•Takeonnewchallenges

•THINKwecanlearnsomethinghard

•THINKwecanlearnfromourmistakes

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Externalize &Expose 238 239 240

drcarolinebuzanko.com81 Externalize Youarenotyourworry • (Sneakytrickstertryingtomakeyouthink thereissomethingwrongwithyou…) 242 243 241 242 243

MishmashofaBrain

Piecedtogetherovermillenia

•Someareascancommunicatedirectly, othersonlyindirectcontact Canholdcontradictinginformationin differentpartsofthebrain NooneCEO.Lotsofsubselves–differentpartsofthebraincan communicateandworktogethereasily

•Nooneparthascomplete information

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AtLeastSevenSubselves TheBestEquippedTakesover

Self-protection

Mateattraction

Materetention

Affiliation

Kincare

Socialstatus

Diseaseavoidance 245

244

•

TheBestEquippedTakesover

•Canargue&fightforcontrol AtLeastSevenSubselves

•Self-protection •Mateattraction

•Materetention

•Affiliation

•Kincare •Socialstatus

•Diseaseavoidance 246

244 245 246

drcarolinebuzanko.com83 InnerDialogue •Alotofbackandforth Integrative–workingthroughascenario •Confrontational–competingtowin •Differentpartsofthebrainactivateddependingontheself-talk •Howwetalktoourselvesinfluencesourbehaviours 247 Externalize totakecontrol 248 RigidRick All-or-nothingAl AvoidantAliso Self-CriticalCarla PermanentPete CatastrophicCam PerfectionistPete FortunetellingFran MindreadingMandy OvergeneralizingOllie OverestimatingOscar NegativeNellie ScarcitySam

Howarethey gettingintheway andwhat’sonthe otherside? 247 248 249

Externalize toInspire

Exposeit

•Remindhowanxietyworks

•Yep,there’sBob,that’swhatit does.

•Wow,itisreallyworkinghardto makemethinktheworsttoday!

•Yeah,weknewit’dshowupnow.It doesn’twantmetowritethetest.

•Itwantsmetoavoidnewthings.

•Itreallyknowshowtotrytostress peopleout. 250

Sayingitoutloudgivesus

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morepower Toexpose,andtousecopingstrategies 251 Becomingan EmotionDetective 250 251 252

drcarolinebuzanko.com85 StartswithAwareness:AnxietyTimeline SITUATIONAWARENESSOF EMOTIONS INTERPRETATION/ EVALUATION REACTION 254 Stress 90Seconds!!!! 255 StartswithAwareness Emotion Physiological Cognitive Body language Motivational (response) Subjective feeling 253 254 255

Physiological

Emotion

MisattributionError

•Mostpowerful

•Usuallyshowsupfirst

•Triggersanxietyresponsebefore weevenrealizeit

257

FeelingsSubjectto Distortion

•Wrongcontext

•Needtolearntocorrectlyinterpret ourinteroceptivesignals

•Betterabletointerpretsignals

•Canmakemoreadaptive decisions

•Boostresilience

•Betteremotionregulationand overallemotionalfunctioning

258

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256 257 258

drcarolinebuzanko.com87 FeelMorebutcan’tinterpretwhat thefeelingsmean Dowhatevertheycantogetridofthem… 259 …Orcontrolwhat theycanintheir externalworld 260 261 Shivers Increasedheartrate Weaklegs Ringingears Blurredvision Muscletension Shaking Trembling Chestpain Headaches

Blushing Changesinbreathing Stomach-ache/Nausea Relaxed Dizzy Racing Tension Achy Sore Hot Cold Tingly Numb Sharp Breathless Shivering Sweating Troubleswallowing Tired 259 260 261

Burningskin/sweating

drcarolinebuzanko.com88 Whenwelabelemotionsand ourexperiences,we •Changeourinterpretationofthem •Changehowourbodyresponds •Dampenedamygdala’sfalsealarm •Turnonprefrontalcortex •Makeadaptivedecisions •Learnthatwehavecontroloverourresponses •Iknowwhatyouare&Iknowhowtohandleyou •Avoidgettingsuckedin–it’sjustapieceof information 262 HonourAllParts •Victim •Empowered •Fighter •Defender •Runner •Hider 263 Understandhowstress showsup= Adaptivethinking Themysteryisgone 264 OfcourseIfeel uncomfortable!No wonder-myadrenal glandshavesentoutall thatyuckystuff. 262 263 264

Self-Coach

Iunderstandwhatmybodyisdoing

Icanhandlewhatmybodydoes

Icanhandlediscomfort

IknowIcanbreathetomakemy brainandbodycalmdown

Expectingphysicalsensationshelps reducesignalstoamygdala

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Validate& Normalize Feelings

Nowonder-youradrenalglands havesentoutallthatyuckystuff. Emotion Cognitive 265 266 267

Thatmakessense!

MomandDadare late–theymust havediedinacar accident.

…Whatit soundslike…

Triggers

•Worriesaboutapanicattack

•Worriesaboutbeing embarrassed

•Worriesaboutsomething happening

•Worriesaboutfacingsomething scary

•Worriesofhavingbadthoughts

Intensifiers

•Contextvariables

•Who

•What

•Where

•When

drcarolinebuzanko.com90 268

StartswithAwareness Writeitout 268 269 270

drcarolinebuzanko.com91 Raising Awarenessto Thoughts (RAT) FASTFORWARD ANDREWIND MOVIETHEATRENOTICETRICKSTER STORIES MOVIES/VIDEOSMODEL 272 Emotion Body language WhatitlookslikeOurbodycommunicateshowwearefeeling •HowwouldothersknowwhenIamfeeling anxiousbylookingatme? 271 272 273

drcarolinebuzanko.com92 PowerPose Emotion Motivational (response) EmotionsAreTellingUsSomethingAboutReality (ourthoughtsmakeupconspiracies)! Assert, Angerdefend ShameAvoid Flee, Fearfreeze Support, Sadnesswithdrawal Connect, Joyengage Attend, explore Excitement 274 275 276

Motivationof Emotions: OurReactions

Whatdowefocuson?

•Dowemovetowardsorawayfromwhatis upsettingus?

Whatdowedo?

•Loudorquiet?

•Bigorsmall?

•Fightorrunaway?

Thoughtsleadto(avoidant)behaviours

People•Iavoidputtingmyhandupinclass willthinkyouare stupid

•IavoidgoingtomyBF’sbecauseshehasa dogDogswillbiteyourfaceoff

Everything•IavoidanythingIcan’tdoperfectly hastobedone perfectly •Ihaveabigtantrumtoavoidgoingout

WhatamIavoidingbecauseofworries?

IavoiddogsbecauseImightgetbit

IavoidsleepoversbecauseImighthavetogotothebathroomin themiddleofthenightandfalldown

Iavoidbeingalonebecausesomethingmighthappen

IavoidorderingfoodbecauseImightmessitup

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accident •IavoidgoingtoschoolIamgoingtothrowupat school 278

Youaregoingtobeinacar

277 278 279

Peoplewillthinkyouarealoser-KickedBobbywhenIlostthegame

Youaregoingtofail-Screamedatmomwhenshemademegotoschool

It’sgoingtopainful-PunchedaholeinthewallwhenIhadtogotothedentist

Theplaneisgoingtocrash-Hidmysuitcasewhenwehadtogototheairport

Nobodylikesyou-Leftthesleepoverwhenmyfriendteasedme

Yourhaircutisterrible-Yelledatmyfriendstogoawaywhentheysaidhi

Yourfriendsfoundnewfriends-Sworeatmyfriendwhenhedidn’ttextmeback

Motivationof Emotions: OurReactions

Intensity&durationofanxiety&the Importanceofthesituation

•Wastheanxietyhelpful?

•Whydiditlastaslongasitdid?

•Whywasitasintenseasitwas?

•Whatfueledit?

drcarolinebuzanko.com94

281

Whatotherbehavioursshowup?

Emotion Subjective feeling

280 281 282

drcarolinebuzanko.com95 Withawareness… 283 Childrencan respond differently 284 285 StartswithAwareness: Practice–willsupportinterventions! Emotion Physiological Cognitive Body language Motivational (response) Subjective feeling 283 284 285

drcarolinebuzanko.com96 StartswithAwareness:Practice! HowamIresponding? Situation?WhatamIfeeling? Recognizing Anxiety 287 288 CoolandCalm (Igotthis) Startingtofeelnervous (ButIthinkIgotit) Really,ReallyNervous (Ack!Help!) ReallyNervous (NotsurehowIamgoingtodo) Panic!Terror! (Iamouttahere) Feelslike Can’tbreathe Sweating Vomiting Nausea Shortbreathes Poundingchest Quickbreathes Clammyhands Muscletensionandheadache Quickerheartbeat Necktension Restless Relaxedmuscles. Deepbreathing. Slowheartbeat 286 287 288

drcarolinebuzanko.com97 289 CoolandCalm (Igotthis) Startingtofeelnervous (ButIthinkIgotit) Really,ReallyNervous (Ack!Help!) ReallyNervous (NotsurehowIamgoingtodo) Panic!Terror! (Iamouttahere) SoundsLookslike likeFeelslike Youare goingtofail thistest! You’regoing toflunkout ofschool Youwon’tbe abletogeta job Youare goingtobe kickedout Youare goingtobe homeless Youare goingtogo tojail StreamofChatter Oncethereis awareness when/howit showsupwe validateand moveto: Confidenceintheirability tohandleworry(the unexpected) •Versusofferingcertainty andcomfort •Versushelpingthem learntoavoidtheworld topreventworry •Versusexpandingtheir answerbank 291 289 290 291

drcarolinebuzanko.com98 Whatanxietyis&whatitdoes…. •Can’tturnthealarmoff •Wecan’tgetridofworry •Wecan’tgetridofthefeelings •Thediscomfortwillstillbethere BUTweCAN •Takecontrolandact •Bereadyforworrywhenitshowsup •Stretchourselvesanddotheoppositefromwhat worryexpects Curiosityis thekey responseto anxiety& trauma 293 Curiouskidshavenervous systemsthatself-regulates Feelsafetoexplore Anxietyandtraumafocusonsurvival–notimetobecurious 292 293 294

drcarolinebuzanko.com99 Mindfulness Buildawareness&toleranceof: •Whatishappeninginthebody •Whatishappeninginourmind •Whatishappeningintheworldaroundus •Howalloftheserelatestoeachother,andtoourbehavioursandinteractions withothers 295 Accept& Unwind 50,000+ Thoughtsa Day 297 295 296 297

drcarolinebuzanko.com100 298 Emotionsaresimply emotions! Wecanexperiencedifferentemotionsdespitetheexactsame circumstances. Howweinterpretthemcausessuffering. Theywilltakeoverifwearen’tself-awareinthemoment. Usethemasalearningopportunity,getcurious! 299 Mindfulness 300 NOTABOUTRELAXINGNOTABOUT CHANGINGTHOUGHTS NOTABOUTFIGHTINGOR IGNORINGTHEM 298 299 300

drcarolinebuzanko.com101 Mindfulness 301 IT’SABOUTLEANINGINTOTHEM& GIVINGTHEMSPACE 01000100 AnxietyDialAcceptanceDial Acceptance Welcominganxietyandallitbrings. Andlivinglifeanyway. 301 302 303

drcarolinebuzanko.com102 Whatareour3options? 305 WhattoAcceptOutofmycontrol •Acknowledge •Identifythelearning opportunities •Focusonsomethingelse WhattoAccept MemoriesImagesBodilySensations EmotionsThoughtsAutomatic responses 304 305 306

drcarolinebuzanko.com103 Acceptance Livinglifeevenwithanxietystillthere Changeourresponse DoIhave control?CanI reducethe causeof stress? Yes/Maybe Stay.Problem solve&dowhat needstobe done Leave No Acceptwhat cannotbe changedand keeponwithlife Buildgratitude Focuson supports Lifestylechanges Staystuckandbe slavetothoughts andfeelings 307 308 309

drcarolinebuzanko.com104 Successatcontrollingobsessions 110 Effortintryingtocontrolobsessions 110 Back&forthbattlewhereobsessionstypicallyalwayswin… Lookatthoughts,notfromthem 310 311 312

drcarolinebuzanko.com105 Defusion •Noticing thoughtsvs. getting caughtin thoughts Past Present Future 315 313 314 315

drcarolinebuzanko.com106

Focusonthephysicalsensations Stressisinevitablesoneedtolearntogowith theflow&acceptwhatwecan’tchange •Practicegettinguncomfortableonpurpose! •Bepresentwithanyunpleasant feelings,physicalsensations,or thoughts FocusonPhysical Sensations Bewithit •Observeitvs.thinkaboutit •Breatheintoit •Expandit •Allowittobethere Sensationsmightchangebut theymightnot.Itdoesn’t matter! 317 Sitwith,accept,&acknowledgeworries Focusonraisingawarenesstothoughts Recognizing them Acknowledging them Disentangling fromthem Accepting them vs.tryingtochangethoughts 316 317 318

Acceptance:Practice!

drcarolinebuzanko.com107 Detach& Enhance Emotionsaresimply emotions! Wecanexperiencedifferentemotionsdespitetheexactsame circumstances. Howweinterpretthemcausessuffering. Theyaremessengers,NOTdictators:Needtosee throughtheemotionaltrickery. 320 Ourthoughtsare nottrustworthy! 319 320 321

RightBrain

drcarolinebuzanko.com108 Remember! •Rightbraincontributes tovisualimages •Mightnothavewords •Talkingwillnothelp •Relationshipiskey

323 MusicCreating Nourishing activitiesReminisce Remember! •Leftbraincontributesto stressedthoughtsand interpretationsofevents& sensoryinformation •Survivalofthebusiest–ruminationgetsstronger 322 323 324

drcarolinebuzanko.com109 Illusionoffear 325 (andallthataccompaniesit)

Mechanicsofvision:Theeyeis likeacamera •Lightbouncesoffobjects •Entersoureyes •Focusedontheretinabythe lens •Retinalimage(2-D)senttothe braintointerpretthe information 326 TerminatorFallacy Howdoweseeandexperiencetheworldin3-D? 327 325 326 327

JustforFun…

drcarolinebuzanko.com110 Surprise! •Informationfromoureyesand earsonlylooselyconnectedto whatweexperience •Fragmented •Ambiguous •Lotsofefforttochangethem into3-D 328 328 329 330

drcarolinebuzanko.com111 Samevisualinformation. Thelightenteringis identical. Noknowledgetodrawfrom experiencetomakethe sensorydatameaningful. Whatwouldothersee? 332 Thefirstdraft 333 331 332 333

drcarolinebuzanko.com112 ANTS Scratchatthe door Burglar Ghost Monster Kidnapper Thefirstdraft 335 Wrong99% ofthetime ANTS Scratchatthe door Sister Dog Something fellinthehall Mom 334 335 336

drcarolinebuzanko.com113 Ourbodyisgoingtorespondbasedonitsbestguess 337 Ourbraindoesn’tcare ifitshazardousornot •Ourbrainwillrespond basedonwhatweneed tosurvive 338 Brainpredictshowtaxing somethingwillbe&ifwehave thecapacitytohandleit •Easiertoquitnowthatfindout,evenif it’sthewrongdecision •Ifweignoreit,wemisstheopportunity tounderstandourtruecapacity •Discomfortistemporary–quittingis forever 339 337 338 339

Theseareonly guesses!!!!

(Basedonunhelpful trickster assumptions)

Leadstospiralling Laughed at No friendsFailHomeless

Acknowledge &Detach!

•Yep,that’syourstoryyou’re tryingtotell.

•Nicefirstdraft.Niceconspiracy.

•Thisisnormal.

•Thisisnotanemergency.

•You’reannoying.

•Iamlearning.

342

drcarolinebuzanko.com114 •Believesomethingbadisforsuregoingtohappen Overestimate •Believeyouknowwhatisgoingtohappen Fortunetelling •Believeoneexperienceisalwaysgoingtohappenagain Overgeneralize •Believeyouknowwhatothersarethinking. Mindreading •Focusonlyonnegativewhilemissingpositives Negativityblind •Mustknow,needstobemyway,yeahbut Rigid •Never,always,nomatterwhat,nothingcanchange All-or-nothing •Ican’tunless…,don’twantto,amsick Avoidant •Iwillalwaysbelikethis. Permanent •Worsecasescenario Catastrophic

340 341 342

drcarolinebuzanko.com115 TheProblem withLanguage Onceupona____________________ There’snoplacelike______________ Blondeshavemore_______________ •Theworstthingaboutmeis •IamsoanxiousIthinkIwilljust 343 344 345

drcarolinebuzanko.com116 Whatwesayaffects ourthoughtsAND changesthe structureofour brains Wecantell ourselveswecan’t or…? Ican’t… Yet Whatif… Ilook forward to… Createspace Whenwearetooclose,wegetdrawnintotheemotionsoftheexperienceand spiraltotheeasywayout. Whenwecancreatespace,wecanrespondinhelpfulways 346 347 348

Detachfrom&Demotethoughts Distancing

•“InoticeI’mhavingthethoughtthat….” •Usethirdpersonlanguage Train,balloons,bubblesclouds,orleavesontheriver Thankthem

Detach&Demote WaroftheWorlds Objectify

•Whatcolour?Howbig?Whatshape?What texture?Howwoulditmoveifitcould?

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Pop-ups NamethatStory Makefunof worriedthoughts Singit Drawcartoons Muteit Sayitreallyfast Sayitinslowmotion Mimicit 351 349 350 351

drcarolinebuzanko.com118 DismissWorriedThoughts 352 DismissWorriedThoughts RollmyeyesYou’reso boring! BigdealSowhat? Demandmorefromworriedthoughts Isthatallyou got? Isthatthebest youcancome upwith? Don’tyouhave something scarier? Can’tyougive memore? JumbledLetters 353 Enhance: CriticalThinking Worrywantsustothinkthevery worst.Therefore,needtobuild awarenessandcriticalthinkingto: •Getunstuckfromrumination •Differentiatehelpfulvs.unhelpful partsofworry •Decidewhethertheyshouldbuy intoit 352 353 354

Thought:Aw.He’sso cute!

Feeling:Scared

Behaviour:Runaway

Feeling:Calm

Behaviour:Pethim

EnhanceCriticalThinking:SeparatefromtheNoise WhatshouldIbuyinto?

Helpful

Iamgoingtohaveso muchfun!

Ican’twaittoseeDanny!

Ihavetorememberto bringmyswimsuit

Enhance Critical Thinking withHelpful Questions

Unhelpful Iamgoingtothrowup(eventhoughI haven’tthrownupinoverfiveyears)

Momisgoingtoforgettopickmeup(even thoughshehasneverforgottenbefore)

Nooneisgoingtoplaywithme(even thoughmyfriendisgoingtobethere)

Allthebadthingsthatwillhappen

Isthereanyshredof usefulnessinthisthought?

Isthisanoldstory?

WhatwouldIgetforbuying intothisstory?

AmIgoingtofollowmy thoughtsormyexperience?

drcarolinebuzanko.com119 355

Dog!

Trigger:

Thought: Heisgoingtobiteme!

355 356 357

Whatwould bebad aboutthat?

WillgetlaughedatIwillcry

Theywon’tbemy friend

EveryonewillthinkI amababy

WhatamI goingtodo next?

Iwillbelonely&fail outofschool&be homeless

•Helpful: Will•Unhelpful: getlaughedat

•Helpful: I•Unhelpful:

•Helpful: Everyone•Unhelpful:

•Helpful:

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willcry

willthinkIam ababy

They•Unhelpful: won’tbemy friend

•Unhelpful: Iwillbelonely&failout ofschool&be homeless 360 358 359 360

•Helpful:

•

Overestimate

•Believesomethingbadisforsuregoingtohappen

Fortunetelling

•Believeyouknowwhatisgoingtohappen

Overgeneralize

•Believeoneexperienceisalwaysgoingtohappenagain

•Believeyouknowwhatothersarethinking. Mindreading

•Focusonlyonnegativewhilemissingpositives Negativityblind

•Mustknow,needstobemyway,yeahbut Rigid

All-or-nothing

•Never,always,nomatterwhat,nothingcanchange

•Ican’tunless…,Idon’twantto,Iamsick Avoidant

•Iwillalwaysbelikethis. Permanent

•Worsecasescenario Catastrophic

PerfectionistPaula GetsintheWayofLife

•

Perfectionismisthemost seriousthinkingtrap& rootofdepression

Focusoncoreconcepts

•Unrealisticexpectations

•Rumination

•

drcarolinebuzanko.com121

Needforapproval

Concernaboutmistakes

Doubtsaboutactions

Additionaltrapslike circumstantialthinking, quality/quantity 363 361 362 363

Perfectionism

Helpfulparts

Helpsusstrivefor excellence

BuildProceduralThinking!

Unhelpfulparts

Becomeparalyzed

Procrastinate&create morestress

Stifleslearningand growth

Narrowsourworld

Makesusperformworse

•Striveforexcellence,butaddressunrealisticstandards

•Emotionsrelatedtoexpectations

•Focusonwhat’snext(vs.circumstances,rumination,should’s)

What’s next?

BuildBinaryThinking!

Makesuccesseasierthanfailure

•LowerthebarforACTION&customize confidence

•Focusonwhatwecandoconfidently nowandbuildfromthere

•Setbenchmarksthatareimpossible tomiss

•Objective:Didyoudoityes/no

•NeveraboutHOWitwasdone

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364 365 366

drcarolinebuzanko.com123 Mental Association Pairadifficult situationwith anactionthat hasnever failed 367 Couldvs.Should •Couldisanoption •Getcuriousaboutpast decisions •Getactivewithcurrent decisions 368 TheImportanceof MistakesandFailure Talkaboutyourownmistakesandfailures Talkaboutothers’experiences 367 368 369

Embracingmistakes

Whatwasthisexperiencelike?

Whatdidyoulearnfromthismistake

Whatwillyoudothenexttimeyouareinthissituation?

Whatadvicecanyoutellothersbasedonthis?

Forgingahead

•Avoidgettingstuck

•Noneedtoaskwhy,lecture, orexplaintheproblem

•HaveTHEMthinkofthehows

•Howwilltheyfixthis mistake?

•Howwilltheymoveon?

•Howwilltheyhandle ______________?

drcarolinebuzanko.com124

Mistakeoftheday/ HonouraryMistakeWall

370 371 372

Ratherthandeflectfailure,focusonthechild’sroleto learnfromtheexperiencetogrowandimprove

1.Whatwasyourrole?

2.Whatcouldyouhavedonedifferently?

3.Whathaveyoulearned?

4.What’snext?

drcarolinebuzanko.com125 Take accountability forfailureand mistakes

Focuson whoYOU wanttobe. Whodoyouwanttobe? •Thinkingofyoucard Thoughtful•Bringfavouritesnack friend •Reviewclassnoteseveryday •CompleteallassignmentsHardworkingstudent •Dochoresafterhomework Helpful•AskifIcanhelpwithdinner daughter •Sharemychocolatebar Kind•Helpmybrotherwithshooting sister 375 373 374 375

drcarolinebuzanko.com126 Perfectionismdoesn’tworkalone All-or-nothingAl •Never,always,no matterwhat, nothingcanchange, noonelikesme NegativeNellie •Focusonlyon negativewhile missingpositives OvergeneralizingOllie •Believeone experienceisalways goingtohappen again 377 •Youneverdoanything right •Noonelikesyou •Everythingyoudosucks •Youalwaysfailandwill continuetofail Henchmen Guesses •Goodandnotsogood •Thispartishard •Iwillfocusononestepat atime Breakinto parts 378 Allornothing: Ican’tdoanything Ican’twrite Ican brainstorm Icanfollow atemplateIcanedit Mathiseasy Reading:EasyGym:easy 376 377 378

PracticeFlexibility: GetUnstuck

Lookslikeyouramygdala hasgottenstuck

•Whatlittlechangecan help?

•Howcanyoutry somethingdifferent?

***Brainstormtobuild flexibleproblemsolving.

drcarolinebuzanko.com127 379 Outofmycontrol •Outcomes Inmycontrol •Process •AcknowledgehowI did/willprepare •Rules:shouldsand musts •Mustknow,needsto bemyway,yeahbut •Mustknow,needsto bemyway,yeahbut RigidRick

379 380 381

drcarolinebuzanko.com128 PracticeFlexibility:GettingUnstuck PracticeMoving! 382 Sharestories! 382 383 384

drcarolinebuzanko.com129 BeCreative! 385 MIXINGUPTHEDAYFINDTHREEWAYSTO LEARNABOUTATOPIC FINDTHREEWAYSTO SHOWWHATYOUKNOW ABOUTATOPIC Unexpectedeventoftheday&howyouhandledit Brainstormandpracticeoptions IwanttoplayUnobut myfriendwandsto playMonopoly Practicebeingflexible PlayMonopolyfirst thenUno Havefun Playmonopoly instead Havefun Findanewgamewe bothwanttoplay Havefun Refusetoplay anythingbutUno Getstuck Bymyself.Nofun. 385 386 387

Chainofflexibility

•Underestimatesour

drcarolinebuzanko.com130

SUREgoingtohappen

probability

•SomethingbadisFOR

•Confusepossibilityand

abilitytohandleit OverestimatingOscar Remember:It’saninitialguess! Untanglepossibility &probability: JustbecauseitCAN happentodoesn’t meanitWILL. 390 GetObjective withEvidence 388 389 390

drcarolinebuzanko.com131 Situation Possibility 1 Possibility 2 Possibility 3 Possibility 4

PermanentPete 391 392 393

•Youwillalwaysbe likethis.

drcarolinebuzanko.com132 394 Temporary •Icanchangemybrain •Thiswillpass Experiment 395 Howlongdoesitlastinthemoment? Howdoesitchange? WhendoesthehenchmenNOTshowup? •Iknowwhatisgoingto happen(andit’snot pretty) FortunetellingFran 394 395 396

HypothesisTesting

Columbo Approach

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Lotsofexperimentsandexperiences needed!

Howsure?(1-10)? •Wasthehypothesisright?

Whatdidyoulearn? 397 •Iknowwhatothersare thinking(andit’sawful).

•

MindreadingMandy

•Guidethemtocreatediscrepancies •Canyoureadeveryone’sminds?

Allthetime?

Witheverything?Orcertain things?

Examples? 397 398 399

•

drcarolinebuzanko.com134 Columbo 400 Does that mean you suck Allofthetime? Someofthetime? Withallthings? Somethings? Whatisandisnottrueofhumannature? •Worsecasescenario •Completelyawful •Completely unmanageable CatastrophicCam 1510 400 401 402

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Lotsofexperimentsandexperiences needed! •Howsure?(1-10)? •Wasthehypothesisright? •Whatdidyoulearn? 403 Bouncebacks Conduct interviews: Thegood, thebad,the ugly 403 404 405

HypothesisTesting!

drcarolinebuzanko.com136 Challenges Whatwould yourpetsay toyou? 407 ThirdPersonBroadens ourPerspective 408 406 407 408

Imissrollcallandwon’tgetyelled

Consofbelieving

Imissbeingchosenforfunjobs.

drcarolinebuzanko.com137

henchmen Prosofbelieving henchmen Icannotgointoclassatthesame timeasmyfriends. Momgetstocomfortmealittle longer. IwillbemorenoticeableifIcome inlate.

atfornotsittingatmydesk.

allthegoodonesaregone.

favourableoutcome? Going Skateboarding withFriends Allthethingsanxietymakes memissouton •Seeingfriends •Sleepovers •Birthdayparties •School •Tryoutsforsports(and thereforesportteams) •Sleepinginownbed •Makingnewfriends 409 410 411

Iamalwayslasttogetabookand

BenefitsCosts Whatisthemost

drcarolinebuzanko.com138 Writeitout! •Iwanttogoontheoutingand havefun,soIamwillingtonot knowwhat’sgoingtohappen •Iwanttobepartoftheplay,so Iamwillingtofeelnervousand gototheaudition •Iwanttoshowmyscience project,soIamwillingtogoto thesciencefairevenifIfeel likeIamgoingtopukeWhatstoryDOyouwantto buyinto?! BuildEpisodic FutureThinkers 413 EpisodicFutureThinkers 414 Depression–hardto seethefuture •Createshopelessness •Nothingwillever change Anxiety–veryvivid.But allscarythings. •Can’tseewhat’s importanttothem. •Needtoseethefuture WITHwhat’s important 412 413 414

FlipReality

drcarolinebuzanko.com139 EpisodicFutureThinkers:20secondsisenough! 415 •Askwhattheyarelookingforwardto •Getdetailed •Draworwriteaboutit •Createguidedvisualizationsbasedontheirresponses Children •Visualizefuturetocreatenewmemories •Buildadetailedscene •Whatisrealthenthatisorisnotrealtoday? •Detectopportunity •WhatdoIwant?HowdoIfeel? Teens&Adults

What’stheopposite? Howdoyoustarttomoveinthatdirection? Imaginingjournals 416 Developpersonalmantras 417 Fallseventimes,getupeight(JapaneseProverb) Onlythosewhodaretofailgreatlycanever achievegreatly(RobertKennedy) Failureistheopportunitytobeginagainmore Intelligently(BenjaminDisraeli) Youmiss100%ofshotsyoudon’ttake. (WayneGretzsky) 415 416 417

•

CopingCards

•

•Iamnotgoingtoletworrygetinmy way.

•Theoutingwillbesomuchfun–thereisnowayIamgoingtomissit!

•Thisworryistemporaryandwillpass.

•

drcarolinebuzanko.com140 418 Thisfeelingisn’tgreat.ButIcanhandleIt. IcanbeanxiousandstilldowhatIneedtodo. Thisistemporary.IwilljustletmybodydoItsthing. Thisisn’tanemergency.Ihavefeltthiswaybeforeand willmakeItthroughagain.

Igotthis.

Iamworriedbutcandoitanyway.

Whatworrysays: 1. 2. 3 420 WhatIamgoingto sayback: 1. 2. 3 CopingCards 418 419 420

Thisismanageable.

drcarolinebuzanko.com141 CopingCard •Anxietyisnormal.Bobisjust beingabully. •Icanbosshimback–Ihave doneitbefore! Mytummyandchesthurt, butthat’sBobtryingtomake meevenmoreworried.It’s notaproblem. •Ican: 421 Lettertoyourfutureself Forwhenyourfutureselfgetsnervous 422 ThepowerofIDon’tKnow 423 421 422 423

Problem solving

drcarolinebuzanko.com142 WhatIknowWhatIdon’tknow Wherewe’re going •Whattime we’releaving WhatIwilleat forlunch Whoisinmy group •Whoour groupleader is WhereIwillsit WhoI’llsitwith •Weather? Whattimewe’ll getback •Wherethe bathroomsare Bugs? •Howmuch walking? Allergicreaction •Snackbreaks Ifthebuswillbe ontime Howbusyit’llbe Howloudit’llbe Helpthembethinkers 425 Independentproblemsolversto figurethingsout Withoutcallsortexts Withoutfakecrutches

Letthemdoit! Nolectures,fixing,orexplaining! Lotsofopportunitiestofigureoutwhatdoes&doesn’t work Kidsneedtoexperience&workthroughdiscomfort Collaboration Brainstormideas Createastep-by-stepplan(&back-up) Pros/cons BreakintopartsHelpful,unhelpful,neutral Self-talk Scaffoldlanguage •Whatwould….do? •Whatworkedbefore? 424 425 426

Problemsolving

Problemsolving: Fearofunknown

•WhatifImissthebus?

•Whatifnoonepicksmeup?

•Whatifsomeoneismean?

•WhatifIhaveanallergicreaction?

•WhatifIgetlost?

•WhatifIamlate? WhatifIhavetogopee?

•WhatifIgethurt?

drcarolinebuzanko.com143

427 WHATISTHE PROBLEM? HOWISITSTRESSFUL? WHATHAPPENS? WHATNEEDSTO CHANGE? WHATOUTCOMEDO IWANT? WHATACTIONSARE NEEDED?

428 (Wecan’tknow,soavoidreassurance.) Let’sfigurethatout. 429

427 428 429

Whatcouldyoudo?

Jim’smom getsaflat tire

•WaitwithJim atthewaiting spot

Jim’smom forgetsto pickmeup

•Goto the office

Theoffice islocked •Find the janitor

Can’tfind thejanitor •Walk home

Modelling

•Ifeelfrustrated.Ineedtotakea minutetothinkwhattodonext.

•Canyouhelpmebrainstorm ideas?

•That’satighttimeline.Iamgoing toplanthisout.

•Iamalittlenervous;Ihavenoidea whatwillhappen.Let’sfigurethis out.

StrengthenProblemsolving: FosterCreativity

•Creativeplayandactivities

•Divergentthinking:Findoutofthebox solutions

•Schoolproblems

•Classroomproblems

•Familyproblems

•Individualsituations

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430

431 432

432 430

drcarolinebuzanko.com145 Noideahowitwillworkout. But,Iamgoingtousewhat I’vegottogetthrough. Createopportunities Worriesknowhowtotrick! BarrierstoBuy-In Convincing Excuses •Preparesme •Motivatesme 433 434 435

drcarolinebuzanko.com146 Dare& Defy 90%ofwhatchildrenandteenslearnisfrom whattheyexperience 437 Don’tunderestimatethepowerofthe anxiousemotionalbrain! •Changeisneurological–weneed tochangethebrain •Behavioursaffectemotionsmore effectivelythanthoughtortalking •Brainischangedthrough EXPERIENCES •Can’tthinkortalkourwayto change •Focusonstrength(behaviours) ratherthanweakness(thoughts)! 438 436 437 438

drcarolinebuzanko.com147 Resilience Abilitytoadaptwelltoadversity, trauma,tragedy,threats,oreven significantsourcesofstress. High resilience Interestin schoolEffective problem Assertive Take initiative ResponsibleEmpathetic and trustworthy Realistic Positive outlook Independent Asksforhelp when needed 439 440 441

drcarolinebuzanko.com148 Resilientkids Effectivelyrespondtoandcope witheverydaychallenges -Thisiswherewearegoing! Warning! Avoidplacingtoomuch emphasisontheindividual child. MUSTDOTHINGS DIFFERENTLY! Becomesadisorderwhenwe dowhatanxietywants. 442 443 444

•

drcarolinebuzanko.com149 DoThingsDifferently! StartwithResponses 445 Motivation ofEmotions: Our Reactions

Whatdowefocuson?

Whatdowedo?

Dowemovetowardsorawayfromwhat isupsettingus?

Loudorquiet?

Bigorsmall?

Fightorrunaway? Wantsme to Yelland hit Dothe opposite! Wants parentsto Letme stayhome Dothe opposite! Wants teachersto Sendme home Dothe opposite! 447 445 446 447

drcarolinebuzanko.com150 DoThingsDifferently! FaceFears 448 Whenkidsavoidthingstheydon’t feelcomfortablewith,theylose thechancetopracticeandgrow Withavoidance,theyneverlearn! BiasedThoughts •Neverlearn thoughtsare biasedandbad thingsmightnot happen Safetybehaviours•Neverlearn Anxiety strengthened •Worriedthoughtsseem believable 450 448 449 450

drcarolinebuzanko.com151 Facefears…andtheunknown Beingbravebuildsimmunesystemtodevelop copingskills Otherwise,leadstoavoidance Learntoresponddifferentlythrough lotsofexperiences Anxiety Shame Guilt Rejection Disappointment Frustration Self-doubt Becomesogoodatmanagingany emotionthatcomesup. Avoiding Rejection Ingrainedin theBrain 453 Why? 451 452 453

RejectionPractice

Askastoretostayopenanextra30minutesforme

Askastrangertotakeaselfiewithme

Askforabiteofastranger’sfoodatarestaurant

Asktomakeanannouncementovertheloudspeakeratagrocerystore

Askastrangerfor$50

“Anyonewhoisn'tembarrassedof whotheywerelastyearprobablyisn't learningenough.”

AlaindeBotton

“Thewaytogreaterconfidenceisnot toreassureourselvesofourown dignity;it’stocometopeacewithour inevitableridiculousness.”

Practice! BeingRidiculous

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Askfora50%discountatastore 454

Asksomeonefortheircar

456 454 455 456

drcarolinebuzanko.com153 Tolerating Uncertainty Exposure •Talkingnotenoughtochangethebrain! Doingmakesstrongermemories •Doinggivesusexperience WorryMUSTshowupforlearningtohappen •Quickerprogress Setagoalonsomething actionable Fromdoingthat,youare goingtolearnsomething new Withoutanysafetybehavioursorthoughts 457 458 459

drcarolinebuzanko.com154 Createnewpathways 460 Brainworksinaddition Brainworksin addition 460 461 462

drcarolinebuzanko.com155 Learning Opportunities

•

•Theirfearedoutcomesareless likelyorseverethantheythink Anxietyitselfissafe,tolerable, andtemporary

Safetybehavioursarenot neededtotolerateanxietyor tostaysafe

FoundationsofEffectiveExposure Contradictinginformation Maintainingvariableseliminated Generalized •Variablestimuli,contentandcontexts Essentially,BehaviouralExperiments! Wearegoingtobedetectives,orscientists,andgoingtocheckout theseconspiracypredictions 465 463 464 465

•Theycanstilllivelifeanddo anything,evenwhilefeeling anxious!

NoSafetyBehaviours

(It’sonlyanillusionofsafetyanyway)

TheProblemwith SafetyBehaviours

•Worsensanxietybecauseno learningishappening(e.g.,no danger,theycanhandleitontheir own)becauseitwasthebehaviour thatpreventedcatastrophe

•Stilltryingtocontrolanxiety(so neverconfrontfears)

•Effortfulandexhausting(which causesmoreanxietyand dysregulation) Speedofrecovery

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Allowed!

directlyrelatesto yourwillingness tofeelanxiety 468 466 467 468

drcarolinebuzanko.com157 Iamlearningandstrengtheningmyproblemsolvingbrain Iamretrainingmybrainandresettingmyalarm system IcandowhatIwanttodo Itwillbetemporary Idon’tknowwhatwillhappen. 470 ButIknow howtodeal. Functional Assessment 469 470 471

FunctionalAssessment: Whatmaintainsanxiety?

Antecedents

•Triggers:Situations,stimuliandoverallcontext

•Externalsituationsandstimuli

•Internalbodysensations

•Intrusivethoughts

•Anticipatedfearedconsequences

Consequences

•Safetybehaviours&othermaladaptivecoping strategies

•Everyone’sresponsestoanxiety

Connectionsbetweenthetwo

Important: Don’tassumeyouknow!

•Mustunderstandthethingtheyworry about(fearcue)ANDthemeaningthey givethatthing

•Whatwillhappeniftheyfacetheirworry withoutcomfort,withoutsafetybehaviours

Snakes

TeenageboyCaroline

•Snakemightbepoisonous

•Snakemightbiteme

•IfIgetbit,Iwillgetaninfection inmylimbs

•Allmylimbswillbeamputated

•Lifewillbeover

•Therefore,needtoavoid

•Disgustresponse!

•Needtovomit

•Therefore,needtoavoid

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474

472 473 474

Whatwould beawful aboutthat?

•Kidswill laughatme

Whatwould beawful aboutthat?

•Iwillbe embarrassed

Whatwould beawful aboutthat?

•Kidswon’t likeme

Whatwould beawful aboutthat?

•Kidswill laughatme

Whatwould beawful aboutthat?

•Iwillbe embarrassed

Whatwould beawful aboutthat?

•Kidswon’t likeme

Antecedents(Triggerstoanxiety)

Snakes

Askingsomeonetoplay

Tryingsomethingnew

Sleepingalone

Beinghomealone

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CreateaMenuofFearedSituations&Stimuli 475 476 477

Beingwithunfamiliarpeople Firedrills Storms Readingoutloudinclass

CreateaMenuofFearedSituations&Stimuli

Togetusstarted:OurfocusisonthePROCESSvs.specificfears

Matchsituations,thoughts,and physiologicalexperiences

Whatdotheyhavetolearn? Whatdotheyhavetodotolearn?

Makeitworthwhile:Includethe hardest,scariestthingstheythink arevalidandneedtobeavoided Nomorethan10

Getthick!

•Whatwashappeningrightbefore?

•Whatdiditfeellikeinyourbody?

•Howintense?

•Howlongdiditlast?

•Whatconspiracywasittryingtospin?

•Whatdidyou?

•Whatdidyoudototrytofeelsafe?

•Howhelpfulwasit?

•Whatendeduphappening?Howdidyou feelafter?

Safety behaviours

Habitsthatmaintain anxiety

•Strategiesto control,avoid,or reduceanxiety

•Createa comprehensivelist ofbehaviours& FUNCTIONofthose behaviours

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478 479 480

Safetybehaviours

Howdothesafetybehaviours

•Preventthefearedoutcomefrom happening?

•Work?

Safety behaviours: Canbe

obviousor subtle

Passiveavoidance

•Purposelyavoidingsituationsbasedonpredictions

•Needtoknowwhattheyavoid,whytheyavoid,andhowtheyavoid

Excessivechecking

•Reassuranceseeking

•Ensuringcertaintyofsafety

•Preventativebehaviours–solidifythebeliefthatthesearewhatsavesthem

Overtcompulsions

•Reduceanxietyordanger/Preventfearedoutcomes

•Negativelyreinforced

•Needtoknowwhattheritualsare,triggers,function,whatwillhappenifthey don’t,andhowtheyfeelafter

Covert(mental)compulsions

•Quickattemptstoreduceanxiety

•Relaxation,distraction,positiveaffirmations

Safetysignals

•Makekidsfeelsafer

SafetyBehaviours

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Sitting strategically (e.g.,nearexits) Having someonewith you Carryinga safetyobject Neverletting heartrateget toohigh Havingphone chargedandon atalltimes MedicationsReassurance seeking Checkinggoogle allthetime Havingwater availableatall times Noteating beforeclass Notgoingto school Asking forgivenessPraying 483 481 482 483

drcarolinebuzanko.com162 SafetyBehaviours! Anxietywilllikelybeatits highestwhendoing exposureswithoutsafety behaviors 484 GoalsforExposure: Processvs.Outcome Learningandconfidencevs. anxietyreduction Gettingunstuck FaceFear Without safety behaviours Without theworst thing happening Or,ifitdoes, theycan handleIt 484 485 486

drcarolinebuzanko.com163 GoalforExposure: BuildTolerance 488 Wantscomfort &Certainty Dooppositeof whatitwants! AnxietyDialWillingnessDial 01000100 487 488 489

drcarolinebuzanko.com164 IfIamuncomfortable ThenIknowIamontherighttrack Settingup Exposure Setupthesituation Rationaleandbuy-in Honesty Remindthemhowanxietyworks Collaborateaplan Testitout! Validate&normalize Evaluate Setupthesituation:Collaborate Togethercreateamenu Chooseawidevarietyofthings, includingthespecificissuethey comeinwith Remindthemthefocusisonthe processratherthanthelist,but wewillpracticethroughthelist Theygettochoosewhat theywanttochoose 492 Severalthingscanmakeiteasier orharder,suchas: •Distance,Time,People DoesNOTneedtobeeasiestfirst) 490 491 492

Youarethe expertandI needyour expertise!

Antecedents(Triggerstoanxiety)

Setupthesituation:GetDetailed(Distance)

Antecedents(Triggerstoanxiety)

Seeingapictureofasnake

Thinkingaboutasnake

Someonetalkingaboutasnake SeeingasnakeinItscage

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Wewillputourexpertheadstogethertofigureoutthebestplan.

Sleepingalone Beinghomealone Beingwithunfamiliarpeople Firedrills Storms Readingoutloudinclass

Snakes Askingsomeonetoplay Tryingsomethingnew

MenuofFearedSituations&Stimuli

495

493 494 495

Seeingsomeoneholdingasnakeacrosstheroom Seeingsomeoneholdingasnakeinfrontofme Snakeslitheringonthegroundinfrontofme Touchingthesnakeassomeoneholdsit Holdingthesnakeonmyown

Getdetailed(Time)

GetDetailed(People)

drcarolinebuzanko.com166 Tipsforsuccess 496 Antecedents(Triggerstoanxiety) Walkingbythesnakecage Standingbythesnakecagefor30seconds Standingbythesnakecagefor2minutes Openingthesnakecage Puttingmyhandinthesnakecagefor30seconds Holdingmyhandinthesnakecagefor2minutes Touchingthesnake Holdingthesnakefor30seconds Holdingthesnakefor5minutes

Tipsforsuccess 497 Antecedents(Triggerstoanxiety) Holdingthesnakewiththepetstoremanager Holdingthesnakewiththepetowner Holdingthesnakewithmymom Holdingthesnakewithnooneelsearound

Rateit ActualLater Awfulness Predicted Awfulness Antecedents(Triggerstoanxiety) 50 Walkingbythesnakecage 70 Standingbythesnakecagefor30seconds 70 Standingbythesnakecagefor2minutes 80 Openingthesnakecage 100Puttingmyhandinthesnakecagefor30seconds 100Holdingmyhandinthesnakecagefor2minutes 100 Touchingthesnake 100 Holdingthesnakefor30seconds 100 Holdingthesnakefor5minutes 496 497 498

drcarolinebuzanko.com167 Avoidthetrap! Slowstheprocess&impedesfearextinction •Reinforcethebigdeal •Reinforcetheanxietystory •Lifedoesn’thappeninalinearway Randomapproachfocusingonwhattheyare mostmotivatedtoworkonwillenhancethe process SettingupExposure Rationale& buy-in Setupthe situation •Standingby thesnakecage for30seconds 499 500 501

SettingupExposures

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SettingupExposure: Honesty! Anxietyisuncomfortable& wedon’tknowwhatis goingtohappen •Anxietyisnormal(ofcourse youaregoingtobescared!) Anxietyissafe(it’smeantto protectyou!) Anxietyistemporary(let’ssee howlongthisfeelinglasts) •Youwillhandleit SettingupExposure: Remindhowanxietyworks 502 503 504

SettingupExposure: Collaborateaspecificplan

•Step-by-stepplan

•Iwillentertheroomandgostraighttothesnake cage

•Iwillstandfacingthecagestraightonandlookat thesnake

•OnceIamatthecage,Cindywillstartthetimerfor 30seconds

•Cindywillstandbythedoorwithnooneelse around

•Whenthealarmisdone,Iwillleavetheroomwith Cindy

•Cindyisonlygoingtolookatthetimer.Sheisnot goingtosayanythingexcept,“Timeisup”

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Collaboratea specificplan &rateit

Rateit 0 •EasyPeasy 50 •Hard.Mayor maynotbe abletohandle it. 100 •Impossible! Catastrophic! 505 506 507

drcarolinebuzanko.com170 Rateit ActualLater Awfulness Predicted Awfulness Antecedents(Triggersto anxiety) 70Standingbythesnake cagefor30seconds Predictionsare importantfor learning! 509 Predictwhat willhappen 510 Ipredictthiswill happen Iwillthrowup Thesnakewillbelet loose Thesnakewillbiteme Iwillcry 508 509 510

1.Thenatureofanxiety

•Anxietyisnormal

•Anxietyissafe

•Anxietyistolerable

•Anxietyistemporary

•Youcanhandleitonyourown

•Withoutothers

Withoutothersafetybehaviours

2.Somethingaboutthespecificissue (basedontheirprediction)

•

drcarolinebuzanko.com171 PredictwhatIwillLearn 511

somethingnew

Youaregoingtolearn

Ourjobisnottoconvince: Learning happens through experience Theyneedto:

Testtheaccuracyoftheir predictions

Maketheirownconclusions

Createnewexpectations 511 512 513

AddressObstacles

Predict:

Whatwillworrysay?

Howwillyourbodyfeel?

Whatwillworrywantyoutodo?

Whatwillworrywantotherstodo?

Address Obstacles

Ithrowup

•Iwill:bringapapertowelwithmetowipeit up

•Cindywill:

•Keeplookingatthetimerandnotsayanything excepttimeisup

•Helpmecleanitupwhentheexposureisover

Worrymakesmefeeloverwhelmed

•Iwill:

•Bringinmycopingcardstotalkback

•Gotothesnakecageanyway

•Cindywill:keeplookingatthetimerandnot sayanythingexcepttimeisup

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Whatworrysays: 1. 2. 3 516 WhatIamgoingto sayback: 1. 2. 3 CopingCards 514 515 516

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Onlywaytocreatenew experiencesthatcontradict witholdworries Nomatterwhat! •Validate&Normalize •Sticktotheplan Evaluate Learninghappenshereto disconfirmconspiracy 519 517 518 519

Testitout

Evaluate

•

EndingExposureSession

•

Important!

•

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ActualLater Awfulness Predicted Awfulness Antecedents(Triggerstoanxiety) 7050 Standingbythesnakecagefor30seconds Ipredictthiswill happen Iwillthrowup Thesnakewillbelet loose Thesnakewillbiteme Iwillcry Whatreallyhappened? Feltnauseabutdidn’t throwup

cage Thesnakedidnothave anycontact Iwasbraveandwalked outwithasmile

Thesnakewasinits

Didthefeared outcomehappen? Yes Didyousurvive? Howmanageable wasit? No Howtolerablewas thedistresswaiting forIttohappen?

Needtosurpassfearedoutcometodisconfirmitasfullyaspossible

Addressanyyeah-but’srightaway

MustlearntheycanhandleANYTHING

Keepingtrackisessential

Mustlearntheycangofurtherthantheworrymadethembelievetheycan

Icanhandleit! 522 Actual Awfulness Predicted Awfulness Antecedents(Triggerstoanxiety) 700 Standingbythesnakecagefor30seconds 520 521 522

Hard Working onIt Success!

Provokeexaggeratedpredictions

•Combinedmultiplefearstimuliinasinglesession

•Moreeffortenhanceslong-termretention

•Maximizeslearningandminimizesanxietyrelapse

Provokeexaggeratedpredictions

Spontaneouslyconfrontthefearof heights,snakes,andelevators(mustall provokethesamefearedoutcome)

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523 524 525

Settingup Exposures

ReasonableRisk

Notabsolutelyrisk-freebut somethingpeopledoeveryday

•Saysomethingstupid

•Dosomethingembarrassing

•Makeamistake

•Sweatinfrontofothers

•Wearsomethingatrocious

•Askacrushout

•Forgettolockthedoor

•Gotothetoiletinpublic

•Walkoutsideonareallywindy day 526

Provokeexaggeratedpredictions

Spontaneouslyconfrontthefearof heights,snakes,andelevators(mustall provokethesamefearedoutcome)

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drcarolinebuzanko.com177 Focusonpairingstoretrainthebrain Activatetogenerate Developnew,competingbraincircuits Buy-in! •Whyarewedoingthis?Howwill itbehelpfulforyou? Howdoesworrygetintheway? 529 530 531

Controlis important

•Signalsofcontrolcankeepourprefrontal cortexonline

•Lackofcontrolsuffocatesourcapacity tocope

•Anotherreasoneliminationdoesn’t work:hopelessness

•Collaborationovertheprocess

•Skillstocreatechoicewhenanxietydoes showup

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532 I.Am. Willing. (Bringit) AnxietyDialWillingnessDial 01000100 532 533 534

Acknowledgingwhensomethingishardandnot pretendingitisn’t Withanhonestappraisal,wecanrespond productively

drcarolinebuzanko.com179 BUT…Fakeit‘tilyoumakeit Doesn’twork 535

RealBravery…

536 NotFearlessness:ChallengestoBeFaced Opportunity Detection Whatarethe opportunities? (vs.threats) 537 535 536 537

Drawontheir resources: Usepastsuccesses

Whatarethingsyouhavealready done/learnedtodo?

•Whatuncertaintywas there?Howdidyouhandle it?

FlipIt

What’stheopposite? Howdoyoustarttomoveinthat direction?

-Whatstepwillyoubemost proudofnextweek?

-Ayearfromnow?

•Iwanttogoontheoutingand havefun,soIamwillingtonot knowwhat’sgoingtohappen

•Iwanttobepartoftheplay,so Iamwillingtofeelnervousand gototheaudition

•Iwanttoshowmyscience project,soIamwillingtogoto thesciencefairevenifIfeel likeIamgoingtopuke

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Usetheirflippedscripts!

540 538 539 540

•

drcarolinebuzanko.com181 AnxietyDialWillingnessDial 01000100

Symptomsare aNatural Response

Physical

Butoftenmisinterpretedas dangerous,whichcreatesa positivefeedbackloop Criticalto addressforall

Notjustpanicdisorder

OCD

Socialanxiety

Performanceanxiety

Phobiasetc. 541 542 543

•

InteroceptiveExposure:LeanIn!

•Confrontworrisomebodysensations

•Evokethingstheyworryabout

•Learning:Theuncomfortablephysicalsensationsaretolerable, temporary,andnotdangerous.

InteroceptiveExposure

Ultimategoal:Toleratethephysicalsensationswithout beingscaredofthem(andthereforemakingthem worse)

•Newlearning:Iamnothavingaheartattack,lose completecontrol,suffocate

InteroceptiveExposure

Beprepared!Weneedtheirconfidenceinthisprocess

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Hyperventilate/fast breathing(dizziness)

Spininplace(dizziness, nausea)

Wearsomethingtight aroundneck(tightnessin throat)

Breathethroughastraw reallyfast(breathlessness)

•Holdyournose!

Shakeheadfastsideto sideordrawingacircle withyournose(dizziness)

Stareatceilinglightfor1 min.andthentrytoread something(blurredvision)

Jumpingjacks,runonthe spotorupanddownstairs (increasedheartrate)

Stareathandsfor2-3min. (unreality)

Getthemtodowhatever causesthefeelings

Step1: Elicit Symptoms

Trya seriesof exercises and record thedata

Lengthoftime

Thephysicalsensationsthatcome up

Theintensityofthosesensations

Thelevelofdistressexperienced (wewanttorepeattheonesthat aremostdistressing)

548

Step2:Exposure

•Pickoneofthemoderate+distressingexercise andrepeatit

•Evokesensationsasintenselyaspossible

•Sustainsensationsbeyondfearedoutcomelimits

•Repeat–especiallywithany“yeahbut’s”

•Nodistractionnoravoidance

•Record

•Lengthoftime&numberofrepetitions

•Sensations

•Intensity

•Levelofdistress

•Assignforhomework!

549

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Maximize Learning

Combineexposures! (Interoceptiveandsituational)

Teenagerwhowasterrifiedshe’d hurtsomeoneifshefeltpanicky(lots ofnightmares)

•Teenagerterrifiedofhavingapanic attackwhiledrivingandgettinginto anaccident

•Womanterrifiedofturningredin frontofothers 550

MaximizeLearning

Combineexposures! (Interoceptiveandsituational)

•Teenagerwhowasterrifiedshe’dhurtsomeone ifshefeltpanicky(lotsofnightmares)

•Teenagerterrifiedofhavingapanicattackwhile drivingandgettingintoanaccident

•Womanterrifiedofturningredinfrontofothers

•Elicitthephysiological response(e.g.,ofpanic) first

•Thenputthemintothe situation

•Inaroomalonewitha friend Inacardriving Inapresentationinfrontof others

551

MaximizeLearning

•Fearofbeingnauseousingymclass:Spin beforegymclassoreatabigmealandthen runaroundontheplayground

•Fearofsuffocatinginclass:Breathethrougha strawreallyfastandgotoclass(withnowater bottle!)

•Fearofheartracingwithnoonearoundwho knowsCPR:runupanddownthestairsand thengoplaywithfriends

552

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550 551 552

ImaginalExposures

Bestforinternalthoughts,visualizations,andtraumaticmemories causingdistress

ImaginalExposures

•Thinkaboutthem

•Justthoughts!

•Temporary

•Notharmful

•Manageable

•Defusionstrategies

•Reviewtheconspiracystory

•

CognitiveFlooding

•Getasanxiousaspossible

•

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•E.g.,repetition,makefunof them

Firstperson Presenttense

•Writeitout

Readitorrecorditand listentoiteveryday

Talkaboutit

Notaboutcontrolling,changing,fixingthe anxiety

•Goforaslongaspossibleorinshorterchunks

555 553 554 555

•Tracktheanxiousfeelingeveryfewminutes

•

Helpfultips

•Model

•Don’trush!

•Gooddebrief

•Lotsofminisessionsclosetogether

•

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Whenexposure isdone

Lotsofopportunities

safetybehaviours

•Candoitontheirownwithout

NOTabouttheirsubjective distress!!!! Willingnesstofaceanxiety provokingexperiences!!! WhensomethingbadDOEShappen Whatdidyoulearn!!!??? 556 557 558

Whensomething badDOEShappen

•Yay!

•Importanceofkeepinggoing

WhenAnxietyOverwhelms

DuringaMeltdown

•Remaincalmandneutral

•Createsafety

•Eyelevel

•Soothingtone

•Disengagebutremainclosefor support

CommonObstacles:

•Lackofunderstandingaboutanxietyandwhat maintainsit

•Unclearrationale

•Rationaleirrelevantorweak

•Fusiontounhelpfulthoughts(e.g.,justifications)

•Excessive(e.g.,toobig,skillsorresourceslacking)

•Kidsnotinvolvedinselectingandplanning

•Exposuresaren’tworrying–tooeasy

•Somethingstillmakesthemfeelsafe(yeahbut…)

•Practicesessionstoonarrow

•Responsepreventionimplementedincorrectly

•Focustoomuchonconvincingorreframing

•Nolearninghappening

•Poorrelationship

•Depression

Afterameltdown

•Acknowledgeandpraise

•Validateandempathize

•Ifcalm

•Workthroughit

•Lessonslearned

•Functionofemotion

•Rewindanddoover

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Habituation

Sendingthewrongmessages

•Anxietyisbad(becauseitmustbe reduced)

•Somethingiswrongwithme (becausetheonlywayIwillbefixed isifIdon’tfeelanxious)

•Misinterpretinevitableand normalunexpectedanxiety becomessignsoffailure

•Hopelessness

•Anxietyiscontrollable

•Exposurecanbecomeanother safetysignal

drcarolinebuzanko.com188 Us! Habituation Caneliminateorunlearn Conditionalsafetylearning Reassurance ExposureTraps Us! Theyneedtogetuncomfortable–weneedtogetoverours 563

562 563 564

HabituationFocusonlearning:Feared outcomebeliefscontradicted?Did youhandleit? Whattodoinstead…

associations Createnewlearningpatternsthat competewitholdones

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Whattodoinstead…

Eliminateanxiety&fearful

LearnedFearGeneralizesEasily Learnedsafetyisrelativelycontextdependent 565 566 567

LearnedFearGeneralizesEasily

•Safetylearningaffectedbycontext

•People

•Place

•Time

•Accesstosafetysignals

•Intensityofarousal

IfStuckon Safety Behaviours

•Wewanttoletgooftheseasquickas possible.

•Useonlytobuildmomentumandsuccessif absolutelyneeded

•Doacostbenefitanalysis(e.g.,short-termgain forlong-termpain) 569

ConditionalSafetyLearningLearnnon-danger-based associationsacrosscontextswith differentpeopleandeverywhere anxietycanshowup

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Whattodoinstead…

568 569 570

AdultsBeing

drcarolinebuzanko.com191 Whattodoinstead… Reassure Support Confidence DoThingsDifferently! CapitalizeonNaturalSituations 572

Helpful •Encouragekidstotry newthings,evenwhen scared •Teachkidstobe comfortableintheworld •Thereisnocertainty 571 572 573

BeingHelpful

Challengesarepartoflife. Dealingwiththemispartoflearning thattheycanhandleit

Optimizeteachable moments

•Letthemtry.

•Letthemfail(butdon’tset themupforfailure)

•Letthemtakeaccountability

•Helpthemunderstand other’sperspectives

•Ensuretheyseethe consequencesoftheir behaviours

•Letthemworkthroughnext stepsandhowtofixthings

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•Whatare3thingstheycanstart tomorrow? •Dressonown •Packownbag Runownbath •Makeownbreakfastorlunch •Solvetheirownconflicts •Maketheirownfriends •Checktheirownhomework Fixtheirowncar •Helpfixtheleakyfaucet 575

Givethemthechancetodo,think,be, try,andmakemistakesontheirown.

574 575 576

Embrace mistakes

Havea“Mistakeoftheday”tosharea mistakeorchallengetheyfaced,how theyfixed/handledit,andwhatthey learned

•Usefeedbackstatementsand questionstoanalyzetheproblem andlearnfromit

Embracingmistakes

Whatwasthisexperiencelike?

Whatdidyoulearntoday?

Whatmistakedidyoumakethattaughtyousomething?

Whatdidyoutryhardattoday?

Whatcanyoulearnfromthis?

Whatwillyoudothenexttimeyouareinthissituation?

Whatadvicecanyoutellothersbasedonthis?

Itisnotwhat theydidwrong thatcounts,but whattheydo next.

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577 578

Letthemtake accountabilityfor mistakes

Ratherthandeflectfailure, focusontheirroletolearnfrom theexperiencetogrowand improve

•Whatwasyourrole?

•Whatcouldyouhavedone differently?

•Whathaveyoulearned?

•What’snext?

Forgingahead

•Avoidgettingstuck

•Noneedtoaskwhy,lecture,or explaintheproblem

•Havethemthinkofhows

•Howwilltheyfixthismistake?

•Howwilltheymoveon?

•Howwilltheyhandle ______________(e.g.,theunfair teacherorthenoisychewerbeside thematlunch)?

Askingforhelp

Resilientkidsknowhowtoseek appropriatesupport

Thekeyistoallowthemtodo thingstheyknowhowtodo themselvesbutagreetoprovide appropriatesupportand guidancewhentheyaskforit

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580 581 582

drcarolinebuzanko.com195 OtherImportantNaturalOpportunities!!! Experiencing rejection, failure,and disappointment Without softeningit Taking ownership, eveninunfair situations Circleof influence Makinga difference Withself,with others,with thesituation Trap:Habituation (i.e.,Onlyendingthesessionwhenanxietyisreduced) AnyGuesses? Caneliminate orunlearn 583 584 585

drcarolinebuzanko.com196 Conditionalsafetylearning Conditionedstimulithatserveassafetycues Reassurance DoThingsDifferently! CreateOpportunities: DailyDosesof StressInoculation 586 587 588

drcarolinebuzanko.com197 ResilienceisAbout: CreatingtheRight WorldwiththeRight Experiences Needtobechallenged (togaindirectexperience workingthroughit)

Createchallenges

Challengeoftheday,week,ormonth

Workthroughthingsontheirown–no hints!

Mightgetfrustratedinthemoment but

Theyneedtolearntheyare capable

Theintrinsicrewardoncesolvedis fargreaterthanifsomeonehelped 589 590 591

•

TakeRisks! 592

Risk-takersadvantage

Exposingkidstoopportunitiesforsomeriskishelpful

•Limitsonscreentime

Learntheskillstheyneedtosurviveearly

•HelpwithImportantevents

Decoratingtheclass

•Eskimoclub

Usingtools

•Planningschoolevents

Opportunities forresilience:

Makingtheir owndecisions

Powerfulidentities

•Learnwhowearebasedonwhatotherstelland valueaboutourselves:Co-creation

•Seethemselvesaspowerfulandrespected

•Kidsfeeltheyhavesomethingtooffertheworld

•Createopportunitiesforkidstoknow themselvesinbetterways

•Spacetoexpressstrengthsanddemonstratethem toothers

•Kidscanmakedecisionsintheirownlives

•Opportunitiestomakedecisionsforthemselves

•Decisionsthatmatter!

Experiencesof powerandcontrol

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592

Createchallenges!

Whoworewhichcolor?

Rachel,LindaandEvewerefriendssittinginacircleonthe grass.

Rachelpassed3chocolatechipcookiestothepersoninblue. Evepassed3macaroonstothepersonwhopassedhercookies tothepersonwearinggreen.

Eachpersonpassed3cookiestothefriendonherleft. Rachel,Linda,andEveweredressedInred,blue,andgreen, butnotnecessarilyinthatorder. Thepersonwhoworegreendidnotgetamacaroon. Thepersonwearingredpassedalong3oatmealcookies.

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LifestyleFocus

Self-guidedexposure

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CommittedAction Notapromiseorhope. Commitmenttobeingthekindof persontheywanttobeanddoing thethingstheywanttodoeven withanxiety. •Ourjobistoensurechildren, teens,andtheirfamilieshavethe toolsandresourcestheyneedto beresilientwithoutus 598

DoThingsDifferently!

Opportunists:Choosingtobeanxiousnowformoresuccesslater

Exposuresonlydoneundersupervisionmore vulnerabletorelapsethanthosewhodoselfguidedexposures 598 599 600

Smash Patterns

drcarolinebuzanko.com201 Self-guidedexposure Exposurehomework Fadingprocedurewithus Promotes Autonomy Confidenceintheirabilitytotolerate anxietyontheirown Workoniteveryday •Focusonwhatskillstheyneedto developspecifically •Problemsolving •Makingmistakes •Askingforhelp •Frustrationtolerance •Persistence 602 Bravery Jar

•Changeitup! Lengthoftime •Distance •Timeofday •Places •People 601 602 603

Smash Patterns

drcarolinebuzanko.com202 Missions You’reonlylimitedbyyourowncreativity! Createthemesfortheweek •Imperfection •Makeaguesswhendon’tknow •Focusonquantityvs.qualityinatimed task •Fastdecisionmaking •Independence •Bookownappointments Buythingsontheirown Orderthefamily’spizza •Talkingtopeople •Askstrangerfortimeordirections •Asksomeonetoplay •Complimentsomeone

•Doopposite •Ofwhatnormallywoulddo Ofwhatworryexpects •Breakworryrules •Createopportunitiesforgreater Independence •Gobeyondcomfort,Besilly! 605 606 604 605 606

drcarolinebuzanko.com203 607 Iamafraidof WhyI shouldtry HowIwillkeepanxietyfromstandingin myway: Willingness ActionPlan Goal: Bigwhy: ThestepsIneedtotake are: Iwilltakethefirststepon(date) at(time) ThediscomfortIam willingtohaveto achievethisgoal: Thoughts Feelings Sensations Urges Icanremindmyselfthat: Strategies Barriers Action Goals WhythisisImportant: 607 608 609

AcknowledgeLearning!

Praisecourageousbehaviour

•Beingbraveiseffortfulandcanbe exhausting!

•Needtokeepthemmotivated

•Reinforceany&signsofwillingnessand flexibility

WhatIcouldn’tdobecause ofworry:

•Gotoschool

•Seefriends

•Askforhelp

Eventhough…. Nevertheless…. Moving

WhatIcandonow:

•Gotoschoolonmyown

•Stayatafriend’shouseonmyown

•Putmyhandupinclass

•Ridethebus

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612

611

Trauma

•Traumaticmemoriesaretrappedintheamygdala&continuouslyringthealarm

•Amygdalahijacksthebrain

•Brainconnections&integrationdisrupted

•Keyfocus:Promotingbrainintegration

•Emotional&thinkingbrain,left&righthemispheres

Stressis Contagious!

Trauma

•Relationshipisessential

•Manytraumasareinterpersonal

•Traumamostlyaffectstherightbrain,which canimpairemotionalconnectionwith others

•Workingtogethersafelypromotes integration&reducesdissociation

•Focusingoncreatingsafetywithyou&in theirbodies

•Notdonethroughtalking:Listeningandfeeling physically

Needtomanageourownstresssowecanprovide:

•Choice

•Nocontrol=fight/flight

•Context

•Nervoussystem:Isitsafetoengage?Orshutdown?

•Connection

•Fundamentalpriority

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614

613 614 615

Trauma

•Stoptrauma

•Howareparentsdoing?

•Theirownanxietyandtraumacan getinthewaywithhowthey interactandrespondtotheir children

•Co-regulationimportantmost often

•Rupturesareinevitablebutthey needtoknowhowtorepairthings whentheydo

•Opportunitiesforchildrenand teenstotoleratenegative affect 616

Trauma

•Normalize

•Ofcourseyou’refeeling thisway!Andbehavingthis way!Nowonder...

•Yourbrainandbodyare doingexactlywhatthey shouldbedoing

•Thisisagoodthing–it tellsusweneedtostay present 617

Trauma Embeddedmemoriesinnervous system

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Whenimplicit,wewillneverhaveamemoryofwhathappensthatwecantalk about.Memorybecomespatternsinthebody.

•

drcarolinebuzanko.com207 Trauma Informationprocessingat threelevels (becausetraumamakesitfeel likethetraumaishappening againatallthreelevels) 619 Thoughts Emotions Body Cannotdifferentiatethe pastandpresent •Traumakeepsusfrozenin thepastanddisconnected fromthepresent 620

PresentNow

GettingUnstucktobe

traumaandeverythingitbringsupinthemoment

•EMDRhelpsusstaypresentandmovingthroughthe

Sensorimotorapproacheshelpshiftthebodyoutofthe frozenstateintodefensiveaction Animalsfinishtheirdefensiveactionandreturntoequilibrium 621 619 620 621

Exposure

Stillneedtowakeuptheamygdalatoworkthrough dysregulation

•Bewith&toleratethefeelings,responses,thoughts,& imagesconnectedtothetrauma

•Dropintothebody

•Maintainpresentawareness&keeptheprefrontal cortexonlinetointegratethebrainvs.dissociate

•Interactandrelate

•It’ssafe!

Helpingthe NervousSystem

CreateaNew Responseto

Trauma: Tolerance

•Don’tgetstuckincontent

•It’snotabouttellingstoriesofthepastor tryingtofigureoutexactlywhatahppened

•BUTitcanbehelpfultofindstrengthsfora reparativenarrative

•It’sabouttoleratingwhateveriscomingupfor themnowinthepresentmoment

•Keepingtheprefrontalcortexonline

•Realizing,respondingto,tolerating,& integratingthetraumaticmemory

•Andlearnthatitwillcometoanend

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623 Practice! Realizingwhatis happeningNOW Re-establishconnectionwithsensoryinput 624 622 623 624

drcarolinebuzanko.com209 Findwhateverworksforthem GroundingKit •Mindfulpractices •Lovingkindness •Mantras •5senses •Walkingmeditation •Payingattentionto whatevercomesupinthe environment 625 Distress-tolerancepractices •Icanbewiththediscomfort •It’ssafe 626 Mindfulness&Trauma •Cancorrectepigeneticsand negativeeffectsoftrauma •Reducingstressandoverallarousal levels(butdon’tfocusonthatas theoutcome!) 627 625 626 627

Beflexible!MUSTFOSTERSAFETY!

•Yoga,relaxation,meditation,bodyscans,mindfulpractices,self-compass, lovingkindnesscancausemorepainand/orcreatepanicattacks

•Evenbeingnicecanbetriggering

•Gotowhereissafe

Avoidretriggering

•Gradualprocessofintegratingthoughts,feelings,andbehaviours

•Clashoftimezones:NOW(sopastmightbeplayingoutinthepresent)

•Firstgetusedtomanagingthephysiologicalsensationsthenaddonthoughts wheretheycanaddressthemsafely,fromthepast,now

WindowofTolerance

•Sacredplace(vs.safeplace)

•Howfeelinthebodybeingthere

•Realorimagined

•Nodemandsorexpectations

•Nothreatsorhurt

•Nointrusionsordistractions

•Getdetailed!

•Allsenses

•Getgrounded

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629

630 628 629 630

•

WindowofTolerance

•

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AttachmentResource

Aperson,animal,orhigherbeing

Gettheminthesacredplaceand imaginingconnectingandbeing withthem

reregulate 631 Recoveryiswhen: You’renotworriedaboutworries Thrive 631 632 633

ANDUS!Tobethere,totolerate thefeelingsandhelpothers

drcarolinebuzanko.com212 634 Worryisstrong •Negative,worrisomeevents createstrongmemories Worrymakesusforget 635 LifeisAboutUpsandDowns (anddownshelpuslearn&getstronger) 636 634 635 636

drcarolinebuzanko.com213 Strategies Barriers Action Goals Beproactive: •Remindhowworryworks •Thosegremlinsareuptotheirusualtricks. •Makingyourforgethowtomanagethis. •Makingyouthinktheworstisgoingtohappen. •Makingyouwanttorunawayandnothaveanyfun. •Tryingtogetstrongerbymakingyouforget. •Sorrydudes,wearegoingtobuildareminderchain. •Linkpastsuccesseswithmanagingworry 639 637 638 639

drcarolinebuzanko.com214 640 Hard Working onIt Success! 641 PillarsofaHealthyLifestyle Exercise Diet Sleep SocialConnection 640 641 642

Exercise!!!

Exercise

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Strengthensthebrain •Chemicalscalmbrain duringstress •Metabolizesstress hormones •Helpsrecoveryand returnbodytorelaxed state 643

•Kidsarenotmeanttositallday •Stretchingandyawningcanreducestress •Exerciseboostsserotoninandmelatonin •Tiresandrelaxesmuscles, •Supportsbodilyprocessesforsleep •Optimizesourabilitytocope •Boostspositivefeelings •Reducesmuscletensionandperceptionofpain •Increasedfeelingsofwell-being •Promotessleep •Stimulatesbraindevelopment •Relievesbuiltupstress 644 Shakeoutenergyintheheatofthemoment 643 644 645

Diet

•Healthygutimportanttoreduce physicalstress

•Sugarandprocessedfoodmaintains highalertandagitatedstate,which createsmorestressinbody

•Alsoinhibitstheneurogenesisandbrain rewiring

•Regulareatingtimeshelpsregulate ourcircadianrhythms

drcarolinebuzanko.com216 Yoga

Dehydrationincreasescortisolandanxiety 648 646 647 648

Powerofwater

SleepTips

•Bestbedtimebasedonwhenneedto wakeup

•Besttowakeuponown

•Samebedandwakeuptimes,even weekends

•Wakeupearlier

•Helpsreduceanxiety

•Getsbodyreadyforbedeasier

•Usethetimeformovementand goodbreakfast

SleepTips

•Optimalenvironment

•DarkandcoolCool

•15-18Celsius(60-65F)

•Bedroomonlyforsleeping,no activities

•Avoidco-sleeping

•Limitstressandconflict

•Positiveactivitiesthroughtheday

Winddownthenight

•Pre-bedtimecalmingroutine45 minutes

•Sameactivitiestohabituatethe bodyforsleep

•Dimlights

•Read,softmusicok

•Gentlestretch

•Reviewofpositives

•Meals&exercise3hoursbefore

•Snack:Proteinandcarb–cottagecheeseor Greekyogurtwithdriedapricots.Turkeyon breadwithmilk.Nococoa.

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650

651 649 650 651

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Connections •

ReduceHome Stress

drcarolinebuzanko.com218 MinimizeScreentime •Exposuretofearfulimagesandstories •Weakentheirabilitytousetheirbrainpowerto overcomeanxietyandbepresent •Noscreens2-3hoursbeforebed!652

Extensioncords!Identify whoisimportantandwho makesyoufeelgood–nurturethoserelationships

Qualitytime

Socialclubs

•

Helpingothers

Familyfun

Avoidoverscheduling

Downtime

Play

Calmmornings

Greentime

Solveconflictsinhealthyways

Routines 652 653 654

•

drcarolinebuzanko.com219 FoodCulture Rechargethe brain& Rebootthe relaxation response Learning hasto happenin advance 655 656 657

658

Relaxation AsaGroup!

•Mindfulness

•Musclerelaxation

•Deepbreathing

•Mantras(Positiveself-talk)

Mindfulness

•Practice!

•Transitiontimes3x/day

5senses countdown

Mindful walking

Mindful eating

Embedded within activities

•5thingsyousee

•4thingsyoufeel

•3thingsyouhear

•2thingsyousmell

•1thingyouareproudof

•Feelbothfeetontheground.

•Feelshiftingyourweight.

•Feelyourlegswingandmakingcontactwith theground.

•Chocolate

•Thefirst3bitesofeverymeal

•Bathing/showering

•Washinghands

•Writing

Mindfulness

•Create!

•Anyrepetitiveaction

•Chewinggum

•Rollingcoins,sorting rainbowloom

•Experiment!

•Physicalactivities

•Music

•Outdoors

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•Thingsthatarepeaceful 659 660

Modelling

•Noticing

•Lightacandleandgazeattheendoftheday

•Frostontrees

•Raindripping

•Takingmindfulwalkoutside

•Useallyoursensestodrinkcoffeeinthe morning

•Smelllaundry

•Soakupthesun

•Commentingasyoudo

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Walking

Mindful

Teatime! 663 661 662 663

FamilyRituals:

drcarolinebuzanko.com222 Rituals: Danceparty 664 •MondayWelcomeBackor FridayShakeoffthestress •Danceletsgooftension •Fewminutesofmusic;letgoof self-consciousness!!!! •Upbeat •Getjittersout •Shakeyourwholebody Everydayisa NewDay •Wipeawayyesterday •Expectittobeagreatone Letitgoritual •Dailyintention •Example:Imaginewashingaway stresswhenwashhands. Stayfullypresenttofeelthesudsand thewater Mantra–Iamlettinggoallofthe stressandworries.Iamgoingtohave arestfulnight. 666 664 665 666

drcarolinebuzanko.com223 Self-soothing •Play! Music Nature Warmbath Wrapinwarmblanketoutofdryer •Hobbies/crafts •Writingordrawing •Touchstonestorememberto practice •Crystals,rock,mineral–naturalresources 667 CopingBox •Makeittogether! •Colouring •Squishballs •Comics •MadLibs •Copingcards •Bubbles •balloons Progressive MuscleRelaxation 667 668 669

Breathingisimportanttoreset (butisnottreatmentonItsown)

BreatheProactively

•BreatheintoLUNGSthenchest

•Slowlyexhalesayingcueword(e.g., calm,relax,letgo)underbreath

•Exhaleshouldbetwiceaslongas inhale

•Letmusclesgolimpandwarm. Loosenfaceandjawmuscles.

•Remaininrestingposition10-15 seconds

•Iftime,consciouslycount10breathes

BreatheProactively

•Visualization

•Blowinghot chocolate

•4squares

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670 671 672

drcarolinebuzanko.com225 Meditation Visualization GetOutside 673 674 675

MeaningfulActivities

drcarolinebuzanko.com226 Fun Anxietysucksthefunout oflife,whichiseffortful Boost the emotional charge!

676 677 678

drcarolinebuzanko.com227 https://bit.ly/POTYpodcast https://bit.ly/overpoweringemotions 679